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Hetal Fichadia MD, Juliana E Hansen MD, FACS Plastic and Reconstructive Surgery Oregon Health and Sciences University
- We sought to analyze the trends in total hospital
Nationwide Trends in Hospital Charges Hetal Fichadia MD, Juliana E - - PowerPoint PPT Presentation
Nationwide Trends in Hospital Charges Hetal Fichadia MD, Juliana E - - PowerPoint PPT Presentation
Immediate Breast Reconstruction - Nationwide Trends in Hospital Charges Hetal Fichadia MD, Juliana E Hansen MD, FACS Plastic and Reconstructive Surgery Oregon Health and Sciences University Introduction We sought to analyze the trends in
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- Nationwide Inpatient Sample was queried
from 2000 to 2009 using ICD-9 codes to identify patients undergoing mastectomy and immediate reconstruction1.
Methods
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- This data was analyzed to follow the rates of
immediate reconstruction, total hospital charges (in dollars) and length of stay over this time frame.
- Statistical significance was assessed by linear
regression and ANOVA using SPSS.
Methods
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- After applying discharge weights, a total of
782,418 patients underwent mastectomy during the study period, out of which 253,238 (32.3%) underwent immediate reconstruction.
- Rate of immediate reconstruction increased
from 26.3% in 2000 to 43.9% in 2009 (p<0.001)
Results
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Mastectomy - charges
5000 10000 15000 20000 25000 30000 Unilateral Bilateral
Total charges (in dollars) Mastectomy charges – Comparison 2000 vs 2009 2000 2009
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Expected vs actual charges for mastectomy
2000 4000 6000 8000 10000 12000 14000 16000 18000 20000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Actual charges- mastectomy Expected charges - mastectomy
Total hospital charges (in dollars)
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Autologous reconstruction charges
10000 20000 30000 40000 50000 60000
Unilateral Bilateral Total charges (in dollars) Autologous Reconstruction - Comparision 2000 vs 2009 2000 2009
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Expected vs actual increase in charges autologous - bilateral
15000 25000 35000 45000 55000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Actual charges bilateral (Median) Expected charges bilateral
- Total hospital charges (in dollars)
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15000 25000 35000 45000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Actual charges for unilateral (median) Expected charges for unilateral
- Expected vs actual increase in charges
autologous - unilateral
Total hospital charges (in dollars)
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5000 10000 15000 20000 25000 30000 35000 40000 45000 50000
Unilateral Bilateral Total charges (in dollars) Implant-based reconstruction - Comparision 2000 vs 2009 2000 2009
Implant-based reconstruction charges
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10000 15000 20000 25000 30000 35000 40000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Actual charges for unilateral (median) Expected charges for unilateral
- Expected vs actual charges
Implant based - unilateral
Total hospital charges (in dollars)
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10000 15000 20000 25000 30000 35000 40000 45000 50000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Actual charges bilateral (Median) Expected charges bilateral
- Expected vs actual charges
Implant based - bilateral
Total hospital charges (in dollars)
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- Increase in charges for breast
reconstruction procedures are significantly higher than the 3.5% per year rise in Medicare spending from 1992 to 20062.
- Adjusting for inflation using the PHCE
(Personal Health Care Expenditure) Price Index from the CMS office of actuary allows for healthcare expenditure rise of 141% in this study period3.
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- The mean length of stay for patients
undergoing implant-based reconstruction changed from 2.2 to 2.04 days.
- Mean length of stay for patients
undergoing autologous reconstruction changed from 3.86 to 3.06 days. Length of Stay
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- The total charges for all immediate breast
reconstruction cases have shown a disproportionate increase over the past decade.
- Further studies are needed to identify the
factors Conclusions
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- Use of ADMs
- Costlier implants
- Increase in microvascular reconstruction
- Increase in complexity of cases
- Increased mark-up of medical devices
Explanations
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- 1. HCUP Nationwide Inpatient Sample (NIS).