背景:最近的CMS计费变化引起了人们对深下腹壁穿支(DIEP)皮瓣乳房重建的保险范围的担忧。本研究比较了横行腹直肌(TRAM)的成本和利用率,DIEP,和背阔肌(LD)皮瓣在乳房重建中的应用。
方法:该研究利用国家住院患者样本数据库来识别接受DIEP的女性患者,TRAM,从2016年到2019年的LD皮瓣程序。关键数据,如患者人口统计,逗留时间,并发症,并对成本(调整为2021美元)进行了分析,关注襟翼类型的差异。
结果:共发现17,770名加权患者,平均年龄为51岁。大多数患者接受了DIEP皮瓣(73.5%),其次是TRAM(14.2%)和LD(12.1%)皮瓣。研究结果表明,DIEP和TRAM襟翼的停留时间(LOS)相似,而LD皮瓣通常有较短的LOS。DIEP和TRAM襟翼的医院总费用与费用之比也相当,而LD皮瓣明显便宜。收入四分等因素,住院的主要支付者,和地理区域显着影响皮瓣的选择。
结论:该研究的结果似乎与TRAM皮瓣比DIEP皮瓣更具成本效益的普遍观点相矛盾。发现使用与TRAM和DIEP皮瓣相关的成本比和住院时间的总医院费用与成本相似。这些发现表明,保险格局的变化,这可能会限制DIEP襟翼的使用,可能会破坏患者的自主权,同时不一定会降低医疗成本。这样的政策转变可能会倾向于成本较低的选择,如LD皮瓣,可能会改变微血管乳房重建的景观。
BACKGROUND: Recent CMS billing changes have raised concerns about insurance coverage for deep inferior epigastric perforator (DIEP) flap breast reconstruction. This study compared the costs and utilization of transverse rectus abdominis myocutaneous (TRAM), DIEP, and latissimus dorsi (LD) flaps in breast reconstruction.
METHODS: The study utilized the National Inpatient Sample database to identify female patients who underwent DIEP, TRAM, and LD flap procedures from 2016 to 2019. Key data such as patient demographics, length of stay, complications, and costs (adjusted to 2021 USD) were analyzed, focusing on differences across the flap types.
RESULTS: A total of 17,770 weighted patient encounters were identified, with the median age being 51. The majority underwent DIEP flaps (73.5%), followed by TRAM (14.2%) and LD (12.1%) flaps. The findings revealed that DIEP and TRAM flaps had a similar length of stay (LOS), while LD flaps typically had a shorter LOS. The total hospital charges to costs using cost-to-charge ratio were also comparable between DIEP and TRAM flaps, whereas LD flaps were significantly less expensive. Factors such as income quartile, primary payer of hospitalization, and geographic region significantly influenced flap choice.
CONCLUSIONS: The study\'s results appear to contradict the prevailing notion that TRAM flaps are more cost-effective than DIEP flaps. The total hospital charges to costs using cost-to-charge ratio and hospital stays associated with TRAM and DIEP flaps were found to be similar. These findings suggest that changes in the insurance landscape, which may limit the use of DIEP flaps, could undermine patient autonomy while not necessarily reducing healthcare costs. Such policy shifts could favor less costly options like the LD flap, potentially altering the landscape of microvascular breast reconstruction.