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

Plast Reconstr Surg. 2020 Mar;145(3):499e-506e. doi: 10.1097/PRS.0000000000006545.

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.

Publication types

  • Comparative Study

MeSH terms

  • Administrative Claims, Healthcare / statistics & numerical data
  • Adult
  • Ambulatory Surgical Procedures / adverse effects
  • Ambulatory Surgical Procedures / economics*
  • Ambulatory Surgical Procedures / methods
  • Breast / abnormalities*
  • Breast / surgery
  • Cohort Studies
  • Cost-Benefit Analysis
  • Databases, Factual / statistics & numerical data
  • Female
  • Health Care Costs / statistics & numerical data
  • Humans
  • Hypertrophy / surgery*
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Male
  • Mammaplasty / adverse effects
  • Mammaplasty / economics*
  • Mammaplasty / methods
  • Middle Aged
  • Patient Readmission / economics
  • Patient Readmission / statistics & numerical data
  • Postoperative Care / economics*
  • Postoperative Care / methods
  • Postoperative Care / statistics & numerical data
  • Postoperative Complications / economics
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Propensity Score
  • Time Factors
  • United States / epidemiology

Supplementary concepts

  • Gigantomastia