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The impact of co-surgeons on complication rates and healthcare cost in patients undergoing microsurgical breast reconstruction: analysis of 8680 patients

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Abstract

Purpose

The use of two operating microsurgeons has been shown to improve the efficiency and reduce the operative duration of microsurgical breast reconstruction (MSBR). However, the impact of this practice on healthcare cost has not been previously assessed. The goal of this study is to query a national claims database to assess complication rates and overall cost in patients undergoing MSBR using co-surgeon (CS) vs. single-surgeon (SS) approach.

Methods

The study cohort, extracted from the MarketScan database, included all female patients who underwent MSBR between 2010 and 2017. Our primary outcome measure was the difference in total healthcare cost between the two operative groups while differences in complication rates were secondary outcome measures.

Results

We identified a total of 8680 patients, out of whom 7531 (87%) underwent MSBR with a SS and 1149 (13%) had a CS. Over the study period, the annual incidence rate of MSBR cases using CS increased from 7.2% in 2010 to 23.3% in 2017 (p < 0.001). Following propensity score matching, complications, emergency room visits, readmissions, and reoperations were all similar between the CS and SS groups. The median total healthcare cost was higher for the CS group [US $76,227 (IQR $67,879) vs. $61,340 (IQR $54,318); p < 0.0001],

Conclusions

Use of the CS approach in MSBR has become increasingly prevalent over time. Analyses of a national claims database suggested that the use of CS is a safe option for patients undergoing MSBR. Further research is needed to optimize CS utilization from a costs and outcomes perspective.

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Acknowledgements

Editorial support was provided by Dawn Chalaire in Scientific Publications Services, Research Medical Library

Funding

This research was supported in part by NCI R0 CA207216 (Ya-Chen Tina Shih, PhD).

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Authors and Affiliations

  1. Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1488, Houston, TX, 77030, USA

    Malke Asaad, Carrie K. Chu & Alexander F. Mericli

  2. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Ying Xu & Ya-Chen Tina Shih

Authors
  1. Malke Asaad
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  2. Ying Xu
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  4. Ya-Chen Tina Shih
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Correspondence to Alexander F. Mericli.

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The authors declare that they have no conflict of interest.

Ethical approval

Given that the Marketscan data are de-identified and that the study does not contain human participants, no ethical approval or informed consent were required.

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Asaad, M., Xu, Y., Chu, C.K. et al. The impact of co-surgeons on complication rates and healthcare cost in patients undergoing microsurgical breast reconstruction: analysis of 8680 patients. Breast Cancer Res Treat 184, 345–356 (2020). https://doi.org/10.1007/s10549-020-05845-6

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  • DOI: https://doi.org/10.1007/s10549-020-05845-6

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