A comparison of long-term cost and clinical outcomes between the two-stage sequence expander/prosthesis and autologous deep inferior epigastric flap methods for breast reconstruction in a public hospital
| Autor: | Fernando Barrera-Pulido, Pedro Infante-Cossío, Araceli Lagares-Borrego, Domingo Sicilia-Castro, Tomás Gómez-Cía, Purificacion Gacto-Sanchez |
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| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Time Factors Breast Implants Cost-Benefit Analysis Mammaplasty medicine.medical_treatment Rectus Abdominis Breast Neoplasms 030230 surgery Prosthesis Design Transplantation Autologous Prosthesis Surgical Flaps 03 medical and health sciences 0302 clinical medicine medicine Humans Prospective Studies Hospital Costs Stage (cooking) Prospective cohort study Mastectomy Hospitals Public business.industry Tissue Expansion Devices Middle Aged Surgery Radiation therapy Spain 030220 oncology & carcinogenesis Cohort Female Breast reconstruction business Follow-Up Studies |
| Zdroj: | Journal of Plastic, Reconstructive & Aesthetic Surgery. 69:196-205 |
| ISSN: | 1748-6815 |
| DOI: | 10.1016/j.bjps.2015.11.027 |
| Popis: | Postmastectomy breast reconstruction involves the use of large amounts of hospital resources. This study provides comparative data on the clinical results and long-term economic costs of two methods of breast reconstruction in a public hospital.A prospective cohort study was performed to evaluate the costs incurred by delayed unilateral breast reconstruction performed using either the two-stage sequence expander/prosthesis (E-P) or autologous deep inferior epigastric flap (DIEP) method during 2005-2013 in 134 patients. The major evaluated variables included previous clinical records, history of radiotherapy, and number of surgical procedures. Total costs accounted for both direct intra- and extra-hospital costs derived from the initial reconstruction and those resulting from associated reoperations due to aesthetic retouches and/or complications.Patients undergoing E-P reconstruction required a higher number of surgery sessions to complete the reconstruction (3.07 vs. 2.32, p0.001) and showed higher rates of surgery-related complications (40.29% vs. 32.82%). No statistically significant differences were found between the two surgical methods in terms of total costs (€18857.77 DIEP vs. €20502.08 E-P; p = 0.89). In the E-P cohort, active smoking and history of radiotherapy were statistically significant risk factors of complications. In the DIEP group, only active smoking was significantly associated with complications.Compared to the E-P method, breast reconstruction using the DIEP method is more cost-effective and involves fewer serious complications that result in reconstruction failure or undesirable aesthetic results. E-P reconstruction presents a higher number of complications that may cause surgical failure or poor outcomes. |
| Databáze: | OpenAIRE |
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