Reconstruction of the Radiated Breast: A National Claims-Based Assessment of Healthcare Resource Use
Oluseyi Aliu, MD, MS, Matthew D. Chetta, MD, Lin Zhong, MD, MPH, Erika Sears, MD, MS, Jennifer F. Waljee, MD, MS, Kevin C. Chung, MD MS, Adeyiza O. Momoh, MD.
University of Michigan, Ann Arbor, MI, USA.
The complication and failure rates in radiated patients undergoing prosthesis-based breast reconstruction are high. We hypothesized that there is higher use of healthcare resources among radiated patients with prosthesis-based reconstruction compared with autologous reconstruction. We compared utilization of healthcare resources between radiated patients who underwent autologous and prosthesis-based reconstruction
Using the MarketScan Claims database we selected radiated patients who underwent mastectomy and breast reconstruction from 2009 to 2012. We tallied the costs of the use of healthcare services related to complications of reconstruction including: emergency room visits, secondary admissions, and treatment of reconstruction failures. We used Wilcoxon rank sum to test our outlined hypothesis.
There were 4,781 patients in the study. A majority of patients (n=3,846, 80%) had prosthesis-based reconstruction. Forty-five percent of prosthesis-based patients used healthcare services for complications compared to 31% for autologous patients. The mean cost of re-admissions due to complications of reconstruction was \ for prosthesis-based patients compared to \ for autologous patients (p = < 0.01). Additionally, 29% of prosthesis-based patients had failures compared to 4% of autologous patients. The mean cost of treating reconstruction failures for prosthesis-based patients was \ compared to \ for autologous patients (p = < 0.01).
Prosthesis-based reconstruction remains more common than autologous methods for radiated patients. It is imperative to rethink the common use of prosthesis-based reconstruction methods in radiated patients as this study shows they are 7 times more likely to fail and cost 6 times more to re-attempt reconstruction compared to autologous reconstruction.
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