Department of General Surgery, The Permanente Medical Group (TPMG), Oakland, CA, USA.
Department of Surgery, University of California San Francisco, East Highland Hospital, Oakland, CA, USA.
Ann Surg Oncol. 2022 Oct;29(10):6288-6296. doi: 10.1245/s10434-022-12127-6. Epub 2022 Jul 29.
Reexcision after breast-conserving surgery (BCS) is costly for patients, but few studies have captured the economic burden to a healthcare system. We quantified operating room (OR) charges as well as OR time and then modeled expected savings of a reexcision reduction initiative.
We performed a retrospective cohort review of all breast cancer patients with BCS between January 1, 2016 and December 31, 2020. Operating room charges of disposable supplies and implants as well as operative time were calculated.
During the 5-year period, the 8804 patients who underwent BCS, 1628 (18.5%) required reexcision. The reexcision cohort was younger (61 vs. 64 years, p < 0.001), more likely to have ductal carcinoma in situ (DCIS) (23.7% vs. 15.2%, p < 0.001), and had larger tumors (T1+T2 73.2% vs. 83.1%, p < 0.001). Reexcision costs represented 39% of total costs, the cost per patient for surgery was fourfold higher for reexcision patients. Reexcision operations comprised 14% of total operating room (OR) time (1848 of 13,030 hours). The reexcision rate for 54 surgeons varied from 7.2-39.0% with 46% (n = 25) having a reexcision rate >20%. A model simulating reducing reexcision rates to 20% or below for all surgeons reduced the reexcision rate to 16.2% overall. Using per procedure data, the model predicted a decrease in reexcision operations by 18% (327 operations), OR costs by 14% ($287,534), and OR time by 11% (204 hours).
Reexcision after BCS represents 39% of direct OR costs and 14% of OR time in our healthcare system. Modest improvements in surgeon reexcision rates may lead to significant economic and OR time savings.
保乳手术后（BCS）的再次切除术对患者来说代价高昂，但很少有研究能够捕捉到这对医疗保健系统的经济负担。我们量化了手术室（OR）费用以及 OR 时间，然后对减少再次切除术的举措的预期节省进行了建模。
我们对 2016 年 1 月 1 日至 2020 年 12 月 31 日期间接受 BCS 的所有乳腺癌患者进行了回顾性队列研究。计算了一次性用品和植入物的手术室费用以及手术时间。
在 5 年期间，8804 名接受 BCS 的患者中有 1628 名（18.5%）需要再次切除术。再次切除术组更年轻（61 岁比 64 岁，p < 0.001），更有可能患有导管原位癌（DCIS）（23.7%比 15.2%，p < 0.001），并且肿瘤更大（T1+T2 73.2%比 83.1%，p < 0.001）。再次切除术的费用占总费用的 39%，再次切除术患者的手术费用是其他患者的四倍。再次切除术手术占总手术室（OR）时间的 14%（1848 小时中的 13030 小时）。54 名外科医生的再次切除术率从 7.2%到 39.0%不等，其中 46%（n = 25）的再次切除术率> 20%。模拟将所有外科医生的再次切除术率降低到 20%或以下的模型将整体再次切除术率降低到 16.2%。使用每例手术的数据，该模型预测再次切除术减少 18%（327 例），手术室费用减少 14%（287534 美元），手术室时间减少 11%（204 小时）。
BCS 后的再次切除术占我们医疗保健系统直接 OR 成本的 39%和 OR 时间的 14%。外科医生再次切除术率的适度提高可能会带来显著的经济和手术室时间节省。
