The financial impact and drivers of hospital charges in contralateral prophylactic mastectomy and reconstruction: a Nationwide Inpatient Sample hospital analysis
- 293 Downloads
Rates of contralateral prophylactic mastectomy (CPM) have increased over the last decade; it is important for surgeons and hospital systems to understand the economic drivers of increased costs in these patients. This study aims to identify factors affecting charges in those undergoing CPM and reconstruction.
Analysis of the Healthcare Cost and Utilization Project National Inpatient Sample was undertaken (2009–2012), identifying women aged ≥18 with unilateral breast cancer undergoing unilateral mastectomy with CPM and immediate breast reconstruction (IBR) (CPM group), in addition to unilateral mastectomy and IBR alone (UM group). Generalized linear modeling with gamma regression and a log-link function provided mean marginal hospital charge (MMHC) estimates associated with the presence or absence of patient, hospital and operative characteristics, postoperative complications, and length of stay (LOS).
Overall, 70,695 women underwent mastectomy and reconstruction for unilateral breast cancer; 36,691 (51.9%) in the CPM group, incurring additional MMHCs of $20,775 compared to those in the UM group (p < 0.001). In the CPM group, MMHCs were reduced in those aged >60 years (p < 0.001), while African American or Hispanic origin increased MMHCs (p < 0.001). Diabetes, depression, and obesity increased MMHCs (p < 0.001). MMHCs increased with larger (p < 0.001) hospitals, Western location (p < 0.001), greater household income (p < 0.001), complications (p < 0.001), and increasing LOS (p < 0.001). MMHCs decreased in urban teaching hospitals and Midwest or Southern regions (p < 0.001).
There are many patient and hospital factors affecting charges; this study provides surgeons and hospital systems with transparent, quantitative charge data in patients undergoing contralateral prophylactic mastectomy and immediate breast reconstruction.
KeywordsContralateral prophylactic mastectomy Reconstruction Charges
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest and there was no internal or external financial support for this study.
- 1.breastcancer.org (2016) [cited 12 Feb 2016] U.S. Breast Cancer Statistics [Internet]. http://www.breastcancer.org/symptoms/understand_bc/statistics
- 3.breastcancer.org (2016) [cited 11 Feb 2017] Is prophylactic mastectomy right for you? [Internet]. http://www.breastcancer.org/treatment/surgery/prophylactic_mast/right-for-you
- 12.Healthcare Cost and Utilization Project (HCUP) (2011) HCUP Nationwide Inpatient Sample (NIS). Agency for Healthcare Research and Quality, RockvilleGoogle Scholar
- 13.Healthcare Cost and Utilization Project (HCUP) (2012) HCUP National Inpatient Sample (NIS). Agency for Healthcare Research and Quality, RockvilleGoogle Scholar
- 14.Healthcare Cost and Utilization Project (HCUP) (2015) [cited 16 Mar 2017] HCUP NIS Trend Weights [Internet]. Agency Healthc. Res. Qual., Rockville. www.hcup-us.ahrq.gov/db/nation/nis/trendwghts.jsp
- 26.Kanonidou Z, Karystianou G (2007) Anesthesia for the elderly. Hippokratia 4:175–177Google Scholar
- 27.Kamath AS, Sarrazin MV, Vander Weg MW, Cai X, Cullen J, Katz DA (2012) Hospital costs associated with smoking in veterans undergoing general surgery. J Am Coll Surg 214(901–908):e1Google Scholar
- 39.Karaca Z, Moore B (2016) Geographic variation in hospital inpatient list prices in the United States, 2013Google Scholar
- 43.Sonig A, Khan IS, Wadhwa R, Thakur JD, Nanda A (2012) The impact of comorbidities, regional trends, and hospital factors on discharge dispositions and hospital costs after acoustic neuroma microsurgery: a United States nationwide inpatient data sample study (2005–2009). Neurosurg Focus 33:E3CrossRefGoogle Scholar
- 45.Missouri Economic Research and Information Center (2016) [cited 21 Mar 2017] Cost of living data series 2016 annual average [Internet]. https://www.missourieconomy.org/indicators/cost_of_living/index.stm
- 49.Fokkema M, Hurks R, Curran T, Bensley RP, Hamdan AD, Wyers MC et al (2014) The impact of the present on admission indicator on the accuracy of administrative data for carotid endarterectomy and stenting. J Vasc Surg 59(32–8):e1Google Scholar