LAUSR

BACKGROUND There is significant cost variation among patients undergoing autologous free flap breast reconstruction. Previous studies hypothesize that factors like length of stay and hospital volume are key drivers of cost; however, how these factors have affected cost have not been well studied. Our study analyzes the factors influencing hospital charges relating to these procedures and their trends over a multiyear time frame. METHODS The Healthcare Cost and Utilization Project's National Inpatient Sample database was analyzed from January 2009 to December 2014. All female patients who were diagnosed with breast cancer or at a high risk for breast cancer who underwent autologous free flap breast reconstruction were included. Variables of interest included demographic data, hospital characteristics, hospitalization data, and total hospital charges. Univariate and generalized linear models were used to examine associations between selected variables and the hospitalization charges, as well as trends in these factors over the years included. RESULTS There were 659,220 female patients diagnosed with breast cancer or had a high risk of breast cancer between 2009 and 2014. Of these patients, 20,050 (3.0%) received autologous free flap breast reconstruction and were included. The mean total hospital charge was US $98,839.33 (SD = US $61,532.04). Regression analysis showed that the proportion of procedures to the total population of potential patients significantly increased over the selected time frame (P = 0.02). The average total charges also increased significantly (P < 0.01), despite a decrease in length of stay (P = 0.05). Procedures performed in the west were associated with significantly higher charges when compared with other regions (US $147,855.42, P < 0.001). Higher hospital charges were also associated with urban hospitals, regardless of teaching status. CONCLUSIONS The overall demand for the autologous free flap breast reconstruction is increasing within the patient population, in conjunction with increasing associated hospital charges. This increase in cost is seen despite an overall decrease in length of stay, originally thought to be the main contributor to regional cost variation. Further studies should be done to develop strategies to better target increased hospitalization charges, because the overall health care burden of this procedure is expected to rise if current trends continue.