A Simplified Cost-Utility Analysis of Inpatient Flap Monitoring after Microsurgical Breast Reconstruction and Implications for Hospital Length of Stay

Abstract Background Enhanced recovery after surgery (ERAS) protocols are effective in decreasing hospital length of stay and inpatient opioid consumption. Implementation of these protocols in abdominally based breast reconstruction has been successful. When a patient is a poor candidate for abdominally based flaps a popular secondary option is the profunda artery perforator (PAP) flap. We present our experience with implementation of our ERAS protocol in patients treated with PAP flaps for breast reconstruction. Methods Retrospective review of patients treated with autologous breast reconstruction using PAP flaps before and after ERAS implementation were performed. Patient characteristics, postoperative oral morphine equivalents (OMEs), and flap data were collected. Results A total of 87 patients were included in this study (58 patients in pre-ERAS and 29 patients in ERAS group). There was no statistical difference in patient age, comorbidities, smoking, and radiation between two groups. The ERAS group had statistically lower hospital length of stay (2.6 vs. 3.8 days), procedure time (315 vs. 433 minutes), postoperative day 0 (54.8 vs. 96.3), postoperative day 1 (29.9 vs. 57.7), and total opioid consumption (103.7 vs. 192.1). There was no statistical difference in average pain scores between two groups. Multivariate analysis revealed that procedure time significantly increased the amount of opioid consumption while ERAS implementation significantly reduced LOS and opioid consumption. Conclusion Use of an ERAS protocol in PAP flap breast reconstruction has not been previously studied. Our work shows that ERAS implementation in PAP flap breast reconstruction significantly reduces inpatient opioid use and length of hospital stay.

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Is Single-Stage Prosthetic Reconstruction Cost Effective? A Cost-Utility Analysis for the Use of Direct-to-Implant Breast Reconstruction Relative to Expander-Implant Reconstruction in Postmastectomy Patients

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000003300 ◽

2017 ◽

Vol 139 (5) ◽

pp. 1204e-1205e

Author(s):

Ritwik Grover ◽

Steven Rueda ◽

Raffi Gurunluoglu

Keyword(s):

Breast Reconstruction ◽

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Single Stage ◽

Utility Analysis ◽

Prosthetic Reconstruction ◽

Implant Reconstruction ◽

Implant Breast Reconstruction

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Combining vascularized lymph node transfer with autologous breast reconstruction: A Surveillance, Epidemiology and End Results (SEER) Database cost-utility analysis

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2020.05.027 ◽

2020 ◽

Vol 73 (10) ◽

pp. 1879-1888

Author(s):

Joseph P Corkum ◽

Michael Bezuhly

Keyword(s):

Lymph Node ◽

Breast Reconstruction ◽

Cost Utility ◽

Cost Utility Analysis ◽

Seer Database ◽

Utility Analysis ◽

Autologous Breast Reconstruction ◽

Lymph Node Transfer ◽

Vascularized Lymph Node Transfer ◽

End Results

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Is Single-Stage Prosthetic Reconstruction Cost Effective? A Cost-Utility Analysis for the Use of Direct-to-Implant Breast Reconstruction Relative to Expander-Implant Reconstruction in Postmastectomy Patients

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000002428 ◽

2016 ◽

Vol 138 (3) ◽

pp. 537-547 ◽

Cited By ~ 26

Author(s):

Naveen M. Krishnan ◽

John P. Fischer ◽

Marten N. Basta ◽

Maurice Y. Nahabedian

Keyword(s):

Breast Reconstruction ◽

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Single Stage ◽

Utility Analysis ◽

Prosthetic Reconstruction ◽

Implant Reconstruction ◽

Implant Breast Reconstruction

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Respiratory syncytial virus hospitalisation trends in children with haemodynamically significant heart disease, 1997–2012

Cardiology in the Young ◽

10.1017/s1047951116000470 ◽

2016 ◽

Vol 27 (1) ◽

pp. 16-25 ◽

Cited By ~ 6

Author(s):

Patricia Y. Chu ◽

Christoph P. Hornik ◽

Jennifer S. Li ◽

Michael J. Campbell ◽

Kevin D. Hill

Keyword(s):

Heart Disease ◽

Respiratory Syncytial Virus ◽

Length Of Stay ◽

The United States ◽

Hospital Length ◽

Cost Utility ◽

Hospital Length Of Stay ◽

Chi Square ◽

Before And After ◽

Syncytial Virus

AbstractObjectiveThe aim of the study was to evaluate the trends in respiratory syncytial virus-related hospitalisations and associated outcomes in children with haemodynamically significant heart disease in the United States of America.Study designThe Kids’ Inpatient Databases (1997–2012) were used to estimate the incidence of respiratory syncytial virus hospitalisation among children ⩽24 months with or without haemodynamically significant heart disease. Weighted multivariable logistic regression and chi-square tests were used to evaluate the trends over time and factors associated with hospitalisation, comparing eras before and after publication of the 2003 American Academy of Pediatrics palivizumab immunoprophylaxis guidelines. Secondary outcomes included in-hospital mortality, morbidity, length of stay, and cost.ResultsOverall, 549,265 respiratory syncytial virus-related hospitalisations were evaluated, including 2518 (0.5%) in children with haemodynamically significant heart disease. The incidence of respiratory syncytial virus hospitalisation in children with haemodynamically significant heart disease decreased by 36% when comparing pre- and post-palivizumab guideline eras versus an 8% decline in children without haemodynamically significant heart disease (p<0.001). Children with haemodynamically significant heart disease had higher rates of respiratory syncytial virus-associated mortality (4.9 versus 0.1%, p<0.001) and morbidity (31.5 versus 3.5%, p<0.001) and longer hospital length of stay (17.9 versus 3.9 days, p<0.001) compared with children without haemodynamically significant heart disease. The mean cost of respiratory syncytial virus hospitalisation in 2009 was $58,166 (95% CI:$46,017, $70,315).ConclusionsThese data provide stakeholders with a means to evaluate the cost–utility of various immunoprophylaxis strategies.

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