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Complications, Costs, and Healthcare Resource Utilization After Staged, Delayed, and Immediate Free-Flap Breast Reconstruction: A Longitudinal, Claims-Based Analysis.

Publication ,  Journal Article
Shammas, RL; Gordee, A; Lee, H-J; Sergesketter, AR; Scales, CD; Hollenbeck, ST; Phillips, BT
Published in: Ann Surg Oncol
April 2023

BACKGROUND: There is a lack of consensus detailing the optimal approach to free-flap breast reconstruction when considering immediate, delayed, or staged techniques. This study compared costs, complications, and healthcare resource utilization (HCRU) across staged, delayed, and immediate free-flap breast reconstruction. PATIENTS AND METHODS: Retrospective study using MarketScan databases to identify women who underwent mastectomies and free-flap reconstructions between 2014 and 2018. Complications, costs, and HCRU [readmission, reoperation, emergency department (ED) visits] occurring 90 days after mastectomy and 90 days after free flap were compared across immediate, delayed, and staged reconstruction. RESULTS: Of 3310 women identified, 69.8% underwent immediate, 11.7% underwent delayed, and 18.5% underwent staged free-flap reconstruction. Staged reconstruction was associated with the highest rate (57.8% staged, 42.3% delayed, 32.0% immediate; p < 0.001) and adjusted relative risk [67% higher than immediate (95% CI: 49-87%; p < 0.001)] of surgical complications. Staged displayed the highest HCRU (staged 47.9%, delayed, 38.4%, immediate 25.2%; p < 0.001), with 16.5%, 30.7%, and 26.5% of staged patients experiencing readmission, reoperation, or ED visit, respectively. The adjusted probability of HCRU was 206% higher (95% CI: 156-266%; p < 0.001) for staged compared with immediate. Staged had the highest mean total cost (staged $106,443, delayed $80,667, immediate $76,756; p < 0.001) with regression demonstrating the adjusted mean cost for staged is 31% higher (95% CI: 23-39%; p < 0.001) when compared with immediate. CONCLUSIONS: Staged free-flap reconstruction is associated with increased complications, costs, and HCRU, while immediate demonstrated the lowest. The potential esthetic benefits of a staged approach should be balanced with the increased risk for adverse events after surgery.

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Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

April 2023

Volume

30

Issue

4

Start / End Page

2534 / 2549

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Postoperative Complications
  • Patient Acceptance of Health Care
  • Oncology & Carcinogenesis
  • Mastectomy
  • Mammaplasty
  • Humans
  • Free Tissue Flaps
  • Female
  • Breast Neoplasms
 

Citation

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Shammas, R. L., Gordee, A., Lee, H.-J., Sergesketter, A. R., Scales, C. D., Hollenbeck, S. T., & Phillips, B. T. (2023). Complications, Costs, and Healthcare Resource Utilization After Staged, Delayed, and Immediate Free-Flap Breast Reconstruction: A Longitudinal, Claims-Based Analysis. Ann Surg Oncol, 30(4), 2534–2549. https://doi.org/10.1245/s10434-022-12896-0
Shammas, Ronnie L., Alexander Gordee, Hui-Jie Lee, Amanda R. Sergesketter, Charles D. Scales, Scott T. Hollenbeck, and Brett T. Phillips. “Complications, Costs, and Healthcare Resource Utilization After Staged, Delayed, and Immediate Free-Flap Breast Reconstruction: A Longitudinal, Claims-Based Analysis.Ann Surg Oncol 30, no. 4 (April 2023): 2534–49. https://doi.org/10.1245/s10434-022-12896-0.
Shammas RL, Gordee A, Lee H-J, Sergesketter AR, Scales CD, Hollenbeck ST, et al. Complications, Costs, and Healthcare Resource Utilization After Staged, Delayed, and Immediate Free-Flap Breast Reconstruction: A Longitudinal, Claims-Based Analysis. Ann Surg Oncol. 2023 Apr;30(4):2534–49.
Shammas, Ronnie L., et al. “Complications, Costs, and Healthcare Resource Utilization After Staged, Delayed, and Immediate Free-Flap Breast Reconstruction: A Longitudinal, Claims-Based Analysis.Ann Surg Oncol, vol. 30, no. 4, Apr. 2023, pp. 2534–49. Pubmed, doi:10.1245/s10434-022-12896-0.
Shammas RL, Gordee A, Lee H-J, Sergesketter AR, Scales CD, Hollenbeck ST, Phillips BT. Complications, Costs, and Healthcare Resource Utilization After Staged, Delayed, and Immediate Free-Flap Breast Reconstruction: A Longitudinal, Claims-Based Analysis. Ann Surg Oncol. 2023 Apr;30(4):2534–2549.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

April 2023

Volume

30

Issue

4

Start / End Page

2534 / 2549

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Postoperative Complications
  • Patient Acceptance of Health Care
  • Oncology & Carcinogenesis
  • Mastectomy
  • Mammaplasty
  • Humans
  • Free Tissue Flaps
  • Female
  • Breast Neoplasms