Healthcare financial concerns have increased administrative attention upon resource utilization and conservation by hospitals and physicians in providing surgical treatments to patients.  Increased emphasis upon outcome metrics and healthcare economics has focused concerns upon in-hospital expenditures for surgical care.  Hospitals have been more attentive to length-of-stay data in an attempt to reduce expenses and increase the contribution margin.  Increased out-patient surgery has been a national trend as well as abbreviated in-hospital care in promoting medical resource conservation.

            Autologous post-mastectomy breast reconstruction is a current standard for aesthetic outcomes of breast reconstruction.  It is generally more resource intensive in hospital days compared to implant reconstruction.  We have analyzed our experience with autologous post-mastectomy breast reconstruction using the transverse rectus abdominus flap over the past twenty years assessing changes in length-of-stay and the determinants of a shorter hospital course.   Demographic, operative, and outcome data were gathered and analyzed on a consecutive series of 169 autologous post-mastectomy breast reconstructions performed using transverse rectus abdominus flaps.  Length-of-stay has diminished from an average of seven days early in our experience to the current average length-of-stay of just three days over the past two years.  Patient age did not correlate with length-of-stay.  Post-operative pulmonary complications increased the length-of-stay. 

            Shorter length-of stay is attributed to 1) delineating patient expectations with pre-operative counseling, 2) improved post-operative pain management, and 3) changes of in-hospital nursing care.  No differences in patient outcomes were identified following implementation of the shorter length-of-stay.  Significant improved utilization was achieved with modest process changes which are easily implemented.