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National Trends In Hospitalization Charges For Implant Based Breast Reconstruction
Yida Cai, BA, Cristin Coquillard, MD, Arvin Smith, BS, Lesley Summerville, BS, ScM, Samuel Boas, BS, Anand Kumar, MD.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.

PURPOSE: Implant based breast reconstruction is the most commonly used type of breast reconstruction. There exists significant cost variation among patients undergoing implant based breast reconstruction. The source of this significant variation in hospital charges are unknown. Research into the source of this cost variation will help reduce overall health care expenditures. Our study analyzes the factors influencing hospital charges relating to implant based breast reconstruction. METHODS: The Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database was analyzed via secondary cross-sectional analysis from January 2009 to December 2014. All female patients who were diagnosed with breast cancer or at a high risk for breast cancer who underwent mastectomy followed by immediate one or two stage implant based breast reconstruction were included. Variables of interest included demographic data, hospital characteristics, hospitalization data and total hospital charges. All charges were adjusted using the consumer price index from May 2019 to inflate all dollar values to the most up-to-date value. Univariate and generalized linear models were used to examine associations between various factors of interest and the final adjusted charge associated with each hospitalization. RESULTS: 659,220 female patients were diagnosed with breast cancer or had a high risk of breast cancer during hospitalization between January 2009 and December 2014. Of these patients, 44,175 (6.7%) received implant-based breast reconstruction and were included in the study. The mean total hospital charge for these patients was $55,188.89 (interquartile range: $37,860.40 - $81,351.37). Regression analysis showed that the proportion of patients who received the procedure to the total population of patients diagnosed with breast cancer did not significantly change between 2009 and 2014 (p = 0.113). However, the average total charges for the hospitalization increased significantly (p < 0.001), despite an overall decrease in length of stay (p < 0.001). Procedures performed in the West were associated with significantly higher charges when compared to other regions ($84,908.78). Higher hospital charges were also associated with urban hospitals, regardless of teaching status. CONCLUSION: There are significant differences in hospital charges associated with patients undergoing implant-based breast reconstruction. Although the overall demand for the procedure did not change significantly within the patient population over the years analyzed, the procedures are associated with increasing hospital charges. This increase in cost is seen over the years despite an overall decrease in length of stay, originally thought to be the main contributor to regional cost variation. Further studies should be done to develop strategies to better target increased hospitalization charges, as the overall healthcare burden of this procedure is expected to rise if current trends continue.


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