Plastic Surgery Research Council
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Presenter: Manish Champaneria, MD
Co-Authors: Workman A; Mattison G; Gupta S
Loma Linda University Medical Center

Introduction: Reimbursements appear to be falling for reconstructive breast surgery despite increased demand for services. This study examined various factors characterizing practices performing reconstructive breast free flaps.

Methods: We examined economic factors contributing to reconstructive breast surgery. This included teaching versus non-teaching hospital status and insurance reimbursements within a national and local database of patients that have undergone free flap breast reconstruction. Data from the 2008 through 2010 Nationwide Inpatient Sample (NIS) was examined in addition to institutional financial records from 2008 through 2012.

Results: A total of 5044 free flaps were coded within the NIS between 2008 and 2010. The percentage of free flaps performed at teaching hospitals was five times greater than those performed within non-teaching hospitals. While the number of free flaps performed at teaching hospitals increased over time, reimbursements steadily decreased.

Conclusion: Free flap breast reconstructive procedures do not appear to be separate from the current trend of declining reimbursements and increased reconstructive caseloads within teaching hospitals. As teaching hospitals continue to bear the largest economic burden of reconstructive procedures, the sustainability of the current reimbursement landscape is beginning to show prominent signs of being overburdened. For the future viability of this surgical field as well as the needs of future patients, further, more in-depth analysis of the potential impact to the overall system is needed.

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