K. Fine1, A. Edalatpour1, B. Michelotti1 1University of Wisconsin Health University Hospital, Department Of Surgery, Madison, WI, USA
Introduction:
Length of Stay (LOS) is a critical metric in hospital management, reflecting the efficiency of healthcare delivery and resource utilization. Furthermore, there is wide variation between hospitals regarding LOS protocol following Deep Inferior Epigastric Perforator (DIEP) flap procedures for breast reconstruction.The financial impact of length of stay (LOS) on hospital operating margins, charges, and reimbursement remains underexplored. This study aims to analyze these financial metrics associated with LOS in DIEP flap breast reconstruction, focusing on patients with LOS of 3, 4, and 5 days.
Methods:
A retrospective analysis was conducted using financial data from DIEP flap breast reconstruction cases performed over the past three fiscal years at a single institution. Patients with more than one operating room (OR) case during hospitalization were excluded. The dataset was filtered to include only cases with LOS of 3, 4, or 5 days due to low case volume < 3 days and > 5 days. The primary outcomes measured were operating margin, charges, and estimated reimbursement per LOS group. Descriptive statistics were performed and displayed as mean ± standard deviation in Table 1. ANOVA was used to assess the statistical significance of differences between LOS groups.
Results:
A total of 202 cases met the inclusion criteria, with 65 cases having a LOS of 3 days, 117 cases with a LOS of 4 days, and 20 cases with a LOS of 5 days. The average operating margins were $42,153, $41,582, and $44,564 for LOS of 3, 4, and 5 days, respectively (P=0.986). Average charges increased with LOS, being $227,157, $251,560, and $278,769 for 3, 4, and 5 days (p=0.002). Similarly, estimated reimbursements were $77,676, $81,258, and $87,491 for 3, 4, and 5 days, respectively (p=0.721). Costs also increased throughout hospitalization from $55,453, $60,453, and $67,123 for 3, 4, and 5 days, respectively (p=0.035), with nursing being the largest contributor to the increase (24%) beetween days 3 and 5. Costs would decrease by approximately $818,400 if all patients were discharged on day 3.
Conclusion:
The financial analysis of DIEP flap breast reconstruction indicates that while both charges and estimated reimbursements increase with LOS, the operating margin does not proportionally reflect these increases. This suggests a need for better cost management strategies to optimize financial outcomes, particularly for longer hospital stays. There is limited research on LOS < 5 days in DIEP flap surgery and surgical complications; interventions to reduce LOS without compromising patient care should be explored, thereby potentially improving financial sustainability in breast reconstruction procedures.