National Trends in Hospitalization Charges for Autologous Free Flap Breast Reconstruction
Yida Cai, BA1, Samuel R. Boas, BS1, Lesley E. Summerville, BS, ScM1, Anand R. Kumar, MD2.
1Case Western Reserve University School of Medicine, Cleveland, OH, USA, 2University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
BACKGROUND: There exists significant cost variation among patients undergoing autologous free flap breast reconstruction. Previous studies have hypothesized that factors like length of stay and hospital volume are key factors driving the variation of cost associated with these procedures, however changes in these factors and cost over multiple years have not been studied. Our study analyzes the factors influencing hospital charges relating to autologous free flap breast reconstruction and their trends over multiple years. METHODS: The Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database was analyzed via secondary cross-sectional analysis from January 2009 to December 2014. All female patients who were diagnosed with breast cancer or at a high risk for breast cancer who underwent autologous free flap breast reconstruction were included. Variables of interest included demographic data, hospital characteristics, hospitalization data and total hospital charges. Charges were adjusted using the consumer price index from May 2019 to inflate all dollar values. Univariate and generalized linear models were used to examine associations between various factors of interest and the final adjusted charge associated with each hospitalization as well as trends in these factors over the years. RESULTS: 848,330 female patients were diagnosed with breast cancer or had a high risk of breast cancer during hospitalization between 2009 and 2014. Of these patients, 23,587 (2.8%) received autologous free flap breast reconstruction and were included in the study. The mean total hospital charge for these patients was $99,138.81 (interquartile range: $56,821.01 - $125,718.48). Regression analysis showed that the proportion of procedures to the total population of potential patients significantly increased over the years (p = 0.02). The average total charges also increased significantly (p<0.01), despite an overall decrease in length of stay (p = 0.05). Procedures performed in the West were associated with significantly higher charges when compared to other regions ($145,655.90). Higher hospital charges were also associated with urban hospitals, regardless of teaching status. CONCLUSIONS: The overall demand for the autologous free flap breast reconstruction appears to be increasing within the patient population, in conjunction with increasing associated hospital charges. This increase in cost is seen despite an overall decrease in length of stay, originally thought to be the main contributor to regional cost variation. Further studies should be done to develop strategies to better target increased hospitalization charges, as the overall healthcare burden of this procedure is expected to rise if current trends continue.
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