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Nationwide trends in hospital charges and length of stay for immediate breast reconstruction

Nationwide trends in hospital charges and length of stay for immediate breast reconstruction. Hetal K Fichadia MD, Juliana E Hansen MD, FACS Division of Plastic and Reconstructive Surgery Oregon Health and Sciences University Plastic Surgery – The Meeting 2013. Introduction.

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Nationwide trends in hospital charges and length of stay for immediate breast reconstruction

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  1. Nationwide trends in hospital charges and length of stay for immediate breast reconstruction Hetal K Fichadia MD, Juliana E Hansen MD, FACS Division of Plastic and Reconstructive Surgery Oregon Health and Sciences University Plastic Surgery – The Meeting 2013

  2. 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.

  3. Methods • Nationwide Inpatient Sample was queried from 2000 to 2009 using ICD-9 codes to identify patients undergoing mastectomy and immediate reconstruction1.

  4. Methods • This data was analyzed to follow the rates of implant based and autologous immediate reconstruction, total hospital charges (in dollars) and length of stay over this time frame. • Statistical significance was assessed using linear regression and ANOVA using SPSS.

  5. 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)

  6. Results • The median total charges(in dollars) for unilateral mastectomy without reconstruction increased from 7780 in 2000 to 17873 in 2009 (229.7%) • For bilateral mastectomy without reconstruction, the charges increased from 9867 in 2000 to 23958 in 2009 (242.8%)

  7. Autologous reconstruction charges • 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%)

  8. Acomparison between expected and actual increase in total charges for autologous reconstruction procedures accounting for inflation from year 2000 to 2009

  9. Implant-based reconstruction charges • 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%). 

  10. A comparison between expected and actual increase in total charges for implant-based reconstruction procedures accounting for inflation from year 2000 to 2009

  11. Length of Stay • 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.

  12. Percentage increase in charges for breast reconstruction procedures are significantly higher than the 3.5% per year rise in Medicare spending from 1992 to 20062. • Adjusting for inflation using the PHCE (Personal Health Care Expenditure) Price Index from the CMS office of actuary allows for healthcare expenditure rise of 141% in this study period3.

  13. Conclusions • The mean total charges for all immediate breast reconstruction cases have shown a significant increase over the past decade, although the length of stay has decreased. • Further studies are needed to identify the factors leading to such an increase as we focus on efforts to reduce health care spending

  14. References 1. HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2007-2009. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp 2. http://www.ahrq.gov/research/findings/factsheets/costs/expriach/index.html 3. http://meps.ahrq.gov/about_meps/Price_Index.shtml

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