Academic Journal
A Simplified Cost-Utility Analysis of Inpatient Flap Monitoring after Microsurgical Breast Reconstruction and Implications for Hospital Length of Stay.
| العنوان: | A Simplified Cost-Utility Analysis of Inpatient Flap Monitoring after Microsurgical Breast Reconstruction and Implications for Hospital Length of Stay. |
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| المؤلفون: | Jablonka, E. M., Lamelas, A. M., Kanchwala, S. K., Rhemtulla, I., Smith, M. L. |
| المصدر: | Journal Articles |
| بيانات النشر: | Donald and Barbara Zucker School of Medicine Academic Works |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Surgery, demo, hisphilso |
| الوصف: | BACKGROUND:The number of free flap take-backs and successful salvages following microsurgical breast reconstruction decreases as time from surgery increases. As a result, the cost of extended inpatient monitoring to achieve a successful flap salvage rises rapidly with each postoperative day. This study introduces a simplified cost-utility model of inpatient flap monitoring and identifies when cost-utility exceeds the thresholds established for other medical treatments. METHODS:A retrospective review of a prospectively maintained database was performed of patients who underwent microsurgical breast reconstruction to identify flap take-back and salvage rates by postoperative day. The number of patients and flaps that needed to be kept on an inpatient basis each day for monitoring to salvage a single failing flap was determined. Quality-of-life measures and incremental cost-effectiveness ratios for inpatient flap monitoring following microsurgical breast reconstruction were calculated and plotted against a $100,000/quality-adjusted life-year threshold. RESULTS:A total of 1813 patients (2847 flaps) were included. Overall flap take-back and salvage rates were 2.4 percent and 52.3 percent, respectively. Of the flaps taken back, the daily take-back and salvage rates were 56.8 and 60.0 percent (postoperative day 0 to 1), 13.6 and 83.3 percent (postoperative day 2), 11.4 and 40.0 percent (postoperative day 3), 9.1 and 25.0 percent (postoperative day 4), and 9.1 and 0.0 percent (>postoperative day 4), respectively. To salvage a single failing flap each day, the number of flaps that needed to be monitored were 121 (postoperative day 0 to 1), 363 (postoperative day 2), 907 (postoperative day 3), 1813 (postoperative day 4), and innumerable for days beyond postoperative day 4. The incremental cost-effectiveness ratio of inpatient flap monitoring begins to exceed a willingness-to-pay threshold of $100,000/quality-adjusted life-year by postoperative day 2. CONCLUSION:The health care cost associated with inpatient flap . |
| نوع الوثيقة: | text |
| اللغة: | unknown |
| Relation: | https://academicworks.medicine.hofstra.edu/publications/6019 |
| DOI: | 10.1097/prs.0000000000006010 |
| الاتاحة: | https://doi.org/10.1097/prs.0000000000006010 https://academicworks.medicine.hofstra.edu/publications/6019 |
| Rights: | undefined |
| رقم الانضمام: | edsbas.C74D3B5F |
| قاعدة البيانات: | BASE |
| DOI: | 10.1097/prs.0000000000006010 |
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