D. Lakhlani1, A. Kang1, S. Francis1, A. Kammien2, L. Zhao2, R. Nazerali1, H. Ayyala2 1Stanford University, School Of Medicine, Palo Alto, CA, USA 2Yale University School Of Medicine, New Haven, CT, USA
Introduction: Same-day mastectomy with immediate alloplastic breast reconstruction has become increasingly common in light of the COVID-19 pandemic and adoption of Enhanced Recovery After Surgery (ERAS) protocols. While previous studies demonstrate similar complication rates between same-day and overnight stays, cost differences remain unexplored in larger patient groups. This study investigates cost differences between overnight stays and same-day discharge procedures.
Methods: Using the MerativeTM MarketScan® Research Databases, 2007-2021, adult female breast cancer patients undergoing mastectomy with concurrent reconstruction were identified and stratified by laterality and length of stay. Propensity score matching ensured fair comparisons, controlling for potential confounding variables. Demographics, 30-day complications, total stay cost, and 1-year complication costs were recorded. Statistical analysis included univariate testing and multivariate linear/logistic regression.
Results: Of 178,134 patients (mean age 49.88 ± 9.63 years), 60% underwent unilateral reconstruction and 40% underwent bilateral reconstruction. 15% of all unilateral reconstructions stayed overnight, while the remaining 85% were same-day procedures. Of bilateral reconstructions, 13% had overnight stays, while the remaining 87% were same-day discharges. From 2007-2021, overnight procedures showed a strong negative correlation between years and visits (r = -0.96, p<0.001). Same-day procedure visits initially increased from 2007-2012, followed by a decreasing trend with an insignificant negative correlation (r = -0.47, p = 0.074). Multivariate logistic regression revealed increased odds of complications such as hematomas, wound dehiscence, and post-op infection in overnight unilateral procedures (vs. same-day unilateral), adjusting for older age, year, region, and higher comorbidity levels determined using the Elixhauser Comorbidity Index. In a multivariate linear regression, overnight procedures increased total cost. The estimated increase in unilateral and bilateral overnight total costs is $14,250.00 and $14,790.00, respectively (95% CI: 1.41e+04, 1.44e+04, p<0.001; 95% CI: 1.45e+04, 1.51e+04, p <0.001). Notably, overnight procedures are associated with a $6701.62 increase when considering complication costs within 1 year following unilateral procedures and a $4061.68 increase following bilateral procedures (95% CI: 5983.99, 7419.24, p<0.001; 95% CI: 3358.62, 4764.75, p<0.001).
Conclusion: Overnight stays for unilateral and bilateral reconstructions, compared to same-day discharge, correlate with higher postoperative complications, total costs, and 1-year complication expenses. Analyzing cost disparities between different stay durations and facilities (hospital-based vs. surgery center) can optimize healthcare delivery, cost-effectiveness, and patient outcomes.