PRSonally Speaking

Thursday, February 13, 2014

Articles of Interest Sneak Peak: Comparative Analysis of 18-Month Outcomes and Costs of Breast Reconstruction Flap Procedures
At least twice a month, PRSonally Speaking posts full abstracts of interesting or potentially controversial articles from a future issue. This 'sneak preview' of a hot article is meant to give you some food for thought and provide you with topic for conversation among colleagues.
When the article is published in print with the March issue, it will be FREE for a period of Two Months, to help the conversation continue in the PRS community and beyond. So read the abstract, join the conversation and spread the word.
This week we present the introduction to "Comparative Analysis of 18-Month Outcomes and Costs of Breast Reconstruction Flap Procedures" by Israeli et al.

Background: Data from large-scale studies of breast reconstruction surgery outcomes and downstream costs are lacking. We assessed outcomes, patient return rates, and
costs across a large, geographically diverse patient population undergoing autologous breast reconstruction.

Methods: Insurance claims for patients undergoing free flap, latissimus dorsi (LD) flap, or transverse rectus abdominus myocutaneous (TRAM) flap autologous breast reconstruction were extracted from a US healthcare database. Claims for an 18-month period after the initial (index) procedure were analyzed to assess episodes of care, complications, breast procedures, and costs.

Results: Of 828 patients (274 free, 302 LD, 252 TRAM), 35% experienced post-index complications; incidences related to implant/graft/mesh and hematoma/seroma highest in the LD flap arm (19% and 6%, respectively); breast necrosis highest in the free flap arm (8%); and wound complications highest in the TRAM flap arm (6%). Patient returns for complications were 92.7, 84.4, and 115.5/100 patients in the free, LD, and TRAM flap arms (p < 0.05, TRAM vs other arms) and were 105.5, 116.6, and 87.7/100 patients, respectively, for procedures unrelated to complications (p < 0.05, LD vs
TRAM). Nearly all patients returned at least once for treatments unrelated to complications. Mean total costs for index surgery plus post-index events were $56,205, $30,783, and $33,380 in the free, LD, and TRAM flap arms, respectively.
Conclusions: 18-month complication and return rates for post-index events were similar across study arms. The frequency of returns and associated cost of procedures unrelated to complications points to the inherently staged nature of autologous breast reconstruction.
The full article will be published with the March 2014 issue of PRS, and will be free online for non-subscribers. Until then, we hope this "sneak peek" will pique your interests and start a healthy, meaningful conversation.