Hospital Variation In The Value Of Mastectomy With Immediate Autologous Breast Reconstruction For Cancer: Complications, Readmissions, And Costs
Justin P. Fox, MD, MHS, John P. Fischer, MD, Paris D. Butler, MD, MPH, Joseph M. Serletti, MD, Joshua Fosnot, MD.
University of Pennsylvania, Philadelphia, PA, USA.
Purpose: The cost and quality of autologous breast reconstruction following mastectomy is known to vary across institutions. The purpose of this study was to evaluate the relationship between hospital’s costs of providing this service relative to the outcomes achieved.
Methods: From 6 state inpatient databases, we identified adult women who underwent mastectomy with autologous reconstruction for cancer between 2008 and 2010. Our primary outcomes were in-hospital morbidity, 30-day readmissions, and 30-day hospital costs of care. Hierarchical generalized linear models were used to calculate hospital level risk standardized outcome rates and costs. Volume weighted correlation coefficients were calculated to quantify the relationship between outcomes. Characteristics of high quality-low cost hospitals were explored.
Results: The final sample included 3,768 women treated at 97 hospitals. At the hospital level, risk standardized morbidity (median=7.6%, interquartile range=2.9%) and readmission (6.0%, 3.0%) rates varied widely as did hospital’s costs ($24,094, $11,500). A direct correlation was noted between in-hospital morbidity and readmission rates (r=0.42, p <0.001), as well as a hospital’s in-hospital morbidity rate and costs (r=0.32, p 0.001). High quality-low cost hospitals tended to be higher volume and have shorter hospitalizations.
Conclusion: Hospital’s cost and quality of providing immediate autologous breast reconstruction following mastectomy varies across hospitals with higher costs being associated with poor quality in many centers. Characteristics and practices of high quality-low cost hospitals should be further explored.
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