Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
Microsurgery. 2024 May;44(4):e31185. doi: 10.1002/micr.31185.
Recent CMS billing changes have raised concerns about insurance coverage for deep inferior epigastric perforator (DIEP) flap breast reconstruction. This study compared the costs and utilization of transverse rectus abdominis myocutaneous (TRAM), DIEP, and latissimus dorsi (LD) flaps in breast reconstruction.
The study utilized the National Inpatient Sample database to identify female patients who underwent DIEP, TRAM, and LD flap procedures from 2016 to 2019. Key data such as patient demographics, length of stay, complications, and costs (adjusted to 2021 USD) were analyzed, focusing on differences across the flap types.
A total of 17,770 weighted patient encounters were identified, with the median age being 51. The majority underwent DIEP flaps (73.5%), followed by TRAM (14.2%) and LD (12.1%) flaps. The findings revealed that DIEP and TRAM flaps had a similar length of stay (LOS), while LD flaps typically had a shorter LOS. The total hospital charges to costs using cost-to-charge ratio were also comparable between DIEP and TRAM flaps, whereas LD flaps were significantly less expensive. Factors such as income quartile, primary payer of hospitalization, and geographic region significantly influenced flap choice.
The study's results appear to contradict the prevailing notion that TRAM flaps are more cost-effective than DIEP flaps. The total hospital charges to costs using cost-to-charge ratio and hospital stays associated with TRAM and DIEP flaps were found to be similar. These findings suggest that changes in the insurance landscape, which may limit the use of DIEP flaps, could undermine patient autonomy while not necessarily reducing healthcare costs. Such policy shifts could favor less costly options like the LD flap, potentially altering the landscape of microvascular breast reconstruction.
最近 CMS 的计费变更引发了人们对深部腹壁下血管穿支皮瓣（DIEP）乳房重建术保险覆盖范围的担忧。本研究比较了横直肌肌皮瓣（TRAM）、DIEP 和背阔肌（LD）皮瓣在乳房重建中的成本和使用情况。
该研究利用国家住院患者样本数据库，确定了 2016 年至 2019 年期间接受 DIEP、TRAM 和 LD 皮瓣手术的女性患者。分析了关键数据，如患者人口统计学、住院时间、并发症和费用（调整为 2021 年美元），重点关注皮瓣类型之间的差异。
共确定了 17770 例加权患者就诊，中位年龄为 51 岁。大多数患者接受了 DIEP 皮瓣（73.5%），其次是 TRAM（14.2%）和 LD（12.1%）皮瓣。研究结果表明，DIEP 和 TRAM 皮瓣的住院时间（LOS）相似，而 LD 皮瓣的 LOS 通常较短。使用成本与收费比的总医院收费与成本也相当，而 LD 皮瓣的费用明显较低。收入四分位、住院主要支付方和地理位置等因素显著影响皮瓣选择。
研究结果似乎与普遍认为 TRAM 皮瓣比 DIEP 皮瓣更具成本效益的观点相矛盾。使用成本与收费比的总医院收费与成本以及与 TRAM 和 DIEP 皮瓣相关的住院时间发现相似。这些发现表明，保险环境的变化可能会限制 DIEP 皮瓣的使用，从而损害患者自主权，而不一定降低医疗保健成本。这种政策转变可能有利于成本较低的选择，如 LD 皮瓣，从而可能改变微血管乳房重建的格局。
