The Optimal Length-of-Stay After Microvascular Breast Reconstruction: A Cost-Utility Analysis

• Published in: Plastic and reconstructive surgery (1963)
• Main Authors: Mericli, Alexander F, Selber, Jesse C, Largo, Rene D, Tran, Jacquelynn P, Liu, Jun, Reece, Gregory P
• Format: Journal Article
• Language: English
• Published: United States 01.08.2022
• ISSN: 1529-4242
• DOI: 10.1097/PRS.0000000000009316

Length-of-stay (LOS) can have a large impact on overall surgical costs. Several studies have demonstrated that a shortened LOS is safe and effective after microvascular breast reconstruction (MBR). The optimal LOS from a cost-utility perspective is not known. The authors used a decision tree model to evaluate the cost-utility, from the perspective of the hospital, of a variety of LOS strategies. Health state probabilities were estimated from an institutional chart review. Expected costs and quality-adjusted life-years (QALY) were assess using Monte Carlo simulation and sensitivity analyses. Over a ten-year period, our overall flap loss and take-back rates were 1.6% and 4.9%, respectively. After rollback, a 3-day LOS was identified as the most cost-effective strategy, with an expected cost of $41,680.19 and an expected health utility of 25.68 QALYs. Monte Carlo sensitivity analysis confirmed that discharge on POD3 was the most cost-effective strategy in the majority of simulations when the willingness-to-pay threshold varied from $50,000-$130,000/QALY gained. This cost-utility analysis suggests that a 3-day LOS is the most cost-effective strategy after MBR.