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A Longitudinal Assessment of Outcomes, Cost, and Healthcare Resource Utilization Following Immediate Breast Reconstruction- Comparing Implant and Autologous Reconstruction
John P Fischer*, Justin P Fox*, Liza C Wu*, Suhail K Kanchwala*, Joshua Fosnot*, Stephen J Kovach*, Joseph M Serletti
Hospital of the University of Pennsylvania, Philadelphia, PA

Objectives
Immediate breast reconstruction (IBR) has increased in recent years, yet long-term comparative data on complication and cost profiles are lacking. We perform a comparison of cumulative healthcare resource utilization and outcomes following implant- and autologous-based breast reconstruction.
Methods
2007-2011 CA, FL, NE, and NY inpatient and ambulatory surgery databases were used (AHRQ HCUP) encompassing 25% of all-payer 2010 population. Discharges for women ≥18 years who underwent mastectomy with breast reconstruction (10/1/2008-10/31/2009), excluding those with metastatic disease. Outcomes included: 90-day surgical complications, 3-year breast surgery procedures, and cumulative healthcare costs.
Results
11,493 patients underwent IBR generating costs of \ million, of which \ million was for secondary procedures. Adjusted 90-day complication profiles favored expander reconstruction (6.5%) relative to direct implant (6.6%) and autologous (13.2%). However, \ adjusted rate of breast procedures within 3 years was highest in expander reconstruction (2,018 per 1,000 discharges) compared to direct implant (1,427 per 1,000 discharges) and autologous (944 per 1,000) (P<0.001). Cumulative adjusted healthcare costs across procedures differed between autologous (\,948), expander (\,366), and direct implant (\,784) modalities (P<.001) (Figure 1).
Conclusion
This analysis provides 3-year data on healthcare resource utilization across common reconstructive modalities from a cohort comprising 25% of the all-payer US population and demonstrates the significant and differing costs of breast reconstruction surgery including revision surgery and the long-term performance of autologous tissue relative to implants.


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