PRS AAPS Oral Proofs 2016
Oluseyi Aliu, MD, MS, Matthew D. Chetta, MD, Lin Zhong, MD, MPH, Erika Sears, MD, MS, Jennifer F. Waljee, MD, MS, Kevin C. Chung, MD, MS, Adeyiza, O. Mohmoh, MD
From the University of Michigan, Ann Arbor, Mich.
PURPOSE: The complication and failure rates in radiated patients undergoing prosthesis-based breast reconstruction are high. We hypothesized that there is higher use of healthcare resources among radiated patients with prosthesis-based reconstruction compared with autologous reconstruction. We compared utilization of healthcare resources between radiated patients who underwent autologous and prosthesis-based reconstruction
METHODS: By using the MarketScan Claims database, we selected radiated patients who underwent mastectomy and breast reconstruction from 2009 to 2012. We tallied the costs of the use of healthcare services related to complications of reconstruction including emergency room visits, secondary admissions, and treatment of reconstruction failures. We used Wilcoxon rank-sum test to test our outlined hypothesis.
RESULTS: There were 4781 patients in the study. A majority of patients (n = 3846, 80%) had prosthesis-based reconstruction. Forty-five percent of prosthesis-based patients used healthcare services for complications compared with 31% for autologous patients. The mean cost of readmissions because of complications of reconstruction was $4842 for prosthesis-based patients compared with $2651 for autologous patients (P < 0.01). In addition, 29% of prosthesis-based patients had failures compared with 4% of autologous patients. The mean cost of treating reconstruction failures for prosthesis-based patients was $2900 compared with $442 for autologous patients (P < 0.01).
CONCLUSIONS: Prosthesis-based reconstruction remains more common than autologous methods for radiated patients. It is imperative to rethink the common use of prosthesis-based reconstruction methods in radiated patients because this study shows they are 7 times more likely to fail and cost 6 times more to reattempt reconstruction compared to autologous reconstruction.