Immediate Breast Reconstruction - Nationwide Trends in Hospital Charges

Introduction -- We sought to analyze the trends in total hospital charges and length of stay among patients undergoing immediate breast reconstruction – both implant based and autologous.

Methods – Nationwide Inpatient Sample was queried from 2000 to 2009 using ICD-9 codes to identify patients undergoing mastectomy and immediate reconstruction¹. This data was analyzed to follow the rates of implant based and autologous immediate reconstruction, total hospital charges and length of stay over this time frame. Statistical significance was assessed using linear regression and ANOVA.

Results – After applying discharge weights, a total of 782418 patients underwent mastectomy during the study period, out of which 253238 underwent immediate reconstruction. Rate of immediate reconstruction increased from 26.3% in 2000 to 43.9% in 2009 (p<0.001). Rate of implant based reconstruction increased from 50.6% of total reconstructions to 74.9% of reconstructions in 2009. The median total charges(in dollars) for unilateral mastectomy without reconstruction increased from 7780 in 2000 to 17873 in 2009 (229.7%), whereas for bilateral mastectomy without reconstruction, the charges increased from 9867 in 2000 to 23958 in 2009 (242.8%). Median total charges for unilateral autologous reconstruction increased from 17356 in 2000 to 42140 in 2009 (242.8%), and for bilateral autologous reconstruction, they increased from 18275 in 2000 to 53015 in 2009 (290.1%). For implant-based reconstruction, total charges for unilateral procedures increased by 279.8% from 12981 in 2000 to 36320 in 2009, where as total charges for bilateral procedures increased from 16284 in 2000 to 46737 in 2009 (287%). Adjusting for inflation using the PHCE Price Index from the CMS office of actuary allows for healthcare expenditure rise of 141% in this study period. The graphs show a comparison between expected and actual increase in total charges for these procedures accounting for inflation. The mean length of stay for patients undergoing implant-based reconstruction changed from 2.2 to 2.04 days. Mean length of stay for patients undergoing autologous reconstruction changed from 3.86 to 3.06 days.

Conclusions – The mean total charges in all immediate reconstruction cases have shown a significant increase over the past decade, although the length of stay has decreased.

Figure 1 Trends in hospital charges for autologous reconstruction

Figure 2 Trends in hospital charges for implant based reconstruction