Outpatient Reduction Mammaplasty Offers Significantly Lower Costs with Comparable Outcomes: A Propensity Score–Matched Analysis of 18,780 Cases

Abstract

Background: Breast reduction mammaplasty is a common plastic surgery operation. Although many contemporary surgeons provide breast reduction mammaplasty as an outpatient procedure, roughly 15 percent of patients are still observed postoperatively. The authors hypothesize that observation confers no safety benefit but engenders significant cost. Methods: The authors reviewed cases of breast reduction mammaplasty in a commercial database and formulated three propensity score–matched cohorts: inpatient, 23-hour observation, and outpatient. Comparisons were made between inpatients and outpatients and between 23-hour observation patients and outpatients. The primary outcome variable was 14-day re-presentation rate to the emergency department or readmission. Financial data were also collected. Results: Comparison of inpatients and outpatients included 1237 patients each (n = 2474 total patients). The 23-hour observation–outpatient comparison included 8153 patients each (n = 16,306 total patients). For inpatients versus outpatients, the 14-day re-presentation rate was 1.4 percent for inpatients and 0.3 percent for outpatients (p < 0.01). The overall surgical complication rate was higher for inpatients (7.8 percent) than for outpatients (4.9 percent) (p < 0.01). Comparing outpatients to 23-hour observation patients, the 14-day re-presentation rate was similar (0.5 percent observation versus 0.3 percent outpatient; p = 0.10). The complication rate was higher for 23-hour observation patients (4.8 percent) than for outpatients (3.2 percent) (p < 0.01). When compared with outpatients (median, $9077), inpatients (median, $19,975) generated $10,898 more in costs. Similarly, 23-hour observation patients (median, $12,451) generated $4050 more in costs than outpatients (median, $8401) (p < 0.01). Conclusions: Outpatient breast reduction mammaplasty is equally safe when compared to observation or admission. Non–outpatient breast reduction mammaplasty had median costs of 148 to 220 percent that of outpatient breast reduction mammaplasty. In an era of cost consciousness, ambulatory reduction mammaplasty may offer a relatively simple method of decreasing expenditures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Evaluating the Impact of ACGME Resident Duty Hour Restrictions on Patient Outcomes for Bilateral Breast Reductions

“…One drawback of using the NIS database for investigating bilateral reduction mammoplasty is the inability to capture mammoplasties performed as an outpatient procedure. 52 However, the majority of the study period draws patient data from a time where many reduction mammoplasties were performed in-patient, ensuring the capture of sufficient data and also records complications attributed to patient care, which is typically the residents’ responsibility. Given the necessity to explore the national scope of the duty hour restrictions, use of different databases such as the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) was not feasible.…”

“…One drawback of using the NIS database for investigating bilateral reduction mammoplasty is the inability to capture mammoplasties performed as an outpatient procedure. 52 However, the majority of the study period draws patient data from a time where many reduction mammoplasties were performed in-patient, ensuring the capture of sufficient data and also records complications attributed to patient care, which is typically the residents' responsibility.…”

Outpatient Prosthetic Based Reconstruction During COVID-19 Pandemic Possible in Selected Patients Without Increased Complications

“…38,39 Some studies have demonstrated a reduction in infection rates and surgical complications with outpatient surgery compared with inpatient surgery. 13,40 Previous authors have demonstrated success with breast reconstruction at ambulatory surgical centers. 41 These facilities can provide increased convenience and privacy for patients, which may be attractive to patients undergoing breast reconstruction.…”

“…[13][14][15][16][17][18] One study revealed that reduction mammaplasty patients experienced fewer infectious complications when inpatient stays were avoided. 13 Few studies assess the outcomes of patients after prosthetic-based reconstruction with same-day discharge. This study aims to compare complication rates between inpatient and outpatient mastectomies with alloplastic reconstruction to determine whether same-day discharge is safe and feasible.…”

Propensity Scoring in Plastic Surgery Research: An Analysis and Best Practice Guide

“…The selection of a match ratio is based on several factors, including the statistical power and sample size needed for the study, the number of participants available for matching, and the ability to obtain optimal and similar distributions of propensity scores in each study group. Both types of matching are acceptable, though one-to-one matching (used in three of the six propensity score matching studies identified in this review) 8,9,11 can increase ease of statistical analysis and interpretability. However, 2:1 (or 3:1, etc.)…”