title: Reduction mammaplasty trends: a quality and fiscal analysis update.
abstract: BACKGROUND
  Reduction mammaplasty remains one of the most common procedures performed by plastic surgeons today. The national health care quality and fiscal environments continue to evolve, with increasing emphasis on outpatient procedures and reduced lengths of stay (LOS). This study was designed to analyze the trends in reduction mammaplasty at our institution during the last 10 years with particular attention to LOS, complication rate, and readmission. We also evaluated the institutional fiscal implications with regard to reimbursement in the changing health care environment.
  
  
  METHODS
  Institutional review board approval was obtained for this retrospective chart review. An analysis of all reduction mammaplasties during the last 10 years was undertaken. Admission status [same day surgery (SDS), outpatient ambulatory, observation, and inpatient], LOS, mortality, morbidity, and readmissions were documented. A financial analysis was also performed comparing trends in hospital revenue and operating income. Revenue was defined as the amount that the hospital received from all sources, whereas operating income was the revenue reduced by all costs incurred to provide services.
  
  
  RESULTS
  In this population, 1779 patients were identified (SDS, 499; outpatient ambulatory or observational, 694; and inpatient, 586). Twenty patients were readmitted within 30 days. The all-cause 30-day readmission rate was 11.24 per 1000 patients. The disease-specific readmission rate was 5.06 per 1000 patients (n=9). Only 1 patient with disease-specific complication requiring readmission had been classified as SDS. No cases of nipple compromise were identified in our study. Revenue per case was highly variable throughout the study period. In general, operating income has decreased during the last decade, despite a small increase for those patients who were truly inpatient.
  
  
  CONCLUSIONS
  Reduction mammaplasty is a common procedure that is safe when performed on an outpatient basis. Institutional operating income, except in the case of inpatients, continues to decrease and could pose a challenge in the future should present trends continue.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, PA 18105-1556, USA. Christine_M.Blaine@lvhn.org
authors.forename: Christine M
authors.initials: CM
authors.lastname: Blaine
authors.forename: Christian R
authors.initials: CR
authors.lastname: Subbio
authors.forename: Sherrine M
authors.initials: SM
authors.lastname: Eid
authors.forename: Robert X
authors.initials: RX
authors.lastname: Murphy
mesh_terms: D005260:Female; D017721:Hospital Costs; D006801:Humans; D007182:Income; D007349:Insurance, Health, Reimbursement; D007902:Length of Stay / Q000191:economics / Q000639:trends*; D016462:Mammaplasty / Q000191:economics / Q000592:standards / Q000639:trends*; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000191:economics / Q000639:trends*; D010414:Pennsylvania; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D011787:Quality of Health Care; D012189:Retrospective Studies