Cost of hospital admission after autologous breast reconstruction and factors associated with increased cost: a population-based cohort study.

BACKGROUND

Demand for reconstructive surgery postmastectomy has risen, prompting evaluation of its economic impact in a publicly funded health care system. We sought to explore factors associated with increased costs of hospital admission following autologous breast reconstruction.

METHODS

We conducted a retrospective cohort study involving patients who underwent autologous breast reconstruction in Ontario, Canada (2005 to 2020). Patients received either a pedicled transverse rectus abdominis myocutaneous (TRAM) flap or free tissue transfer. We analyzed costs from the hospital perspective, from admission to discharge. We used generalized linear models with a γ distribution to identify cost-associated factors.

RESULTS

Of 2634 patients, 378 (14.4%) underwent pedicled TRAM and 2256 (85.7%) underwent free flap reconstruction. The median cost of hospital admission was $8816 (interquartile range $3383 to $90 974). Univariate analysis identified cost drivers including length of stay, reconstruction type, age, income quintile, laterality, and emergency reoperation. Multivariable analysis showed increased costs associated with free flap reconstruction (13% increase, 95% confidence interval [CI] 5% to 22%; p < 0.001), age older than 70 years (31% increase, 95% CI 7% to 61%; p < 0.01), lower income quintile (10% increase, 95% CI 3% to 18%; p = 0.01), and bilateral reconstruction (11% increase, 95% CI 1% to 23%; p = 0.03). Hospital type, geographic region, timing of reconstruction, comorbidities, and rurality were not significantly associated with cost.

CONCLUSION

Free flap reconstruction, bilateral procedures, and advanced age are key drivers of hospital admission costs. These findings may inform policy and resource-allocation strategies in publicly funded systems to optimize value in breast reconstruction care.