title: An evaluation of resource utilisation of single stage porcine acellular dermal matrix assisted breast reconstruction: A comparative study.
abstract: OBJECTIVE
  To evaluate resource utilization of single stage porcine acellular dermal matrix (ADM) assisted breast reconstruction compared with tissue expander (TE), latissimus dorsi flap and implant (LD/I) and latissimus dorsi flap and TE (LD/TE) reconstructive techniques.
  
  
  METHODS
  Clinical data was collected for length of stay, operative time, additional hospitalisations and operative procedures, and outpatient appointments for 101 patients undergoing unilateral implant based breast reconstruction. Resources utilised by ADM (Strattice Reconstructive Tissue Matrix™) patients were analysed and compared to the resource usage of traditional techniques.
  
  
  RESULTS
  25 patients undergoing single stage ADM (ADM/I) were compared with 27 having TE, 32 having LD/I and 17 having LD/TE reconstructions. Follow up was 24 months. Compared to TE, ADM/I had similar length of stay and operative time, lower rate and number of additional procedures, fewer, shorter re-admissions (p < 0.05) and fewer appointments (p < 0.05). Compared to LD/TE, ADM/I had shorter length of stay and operative time (p < 0.05), lower rate and number of additional procedures, fewer, shorter re-admissions (p < 0.05) and fewer appointments (p < 0.05). Compared to LD/I, ADM/I had shorter length of stay (p < 0.05) and operative time (p < 0.05), fewer appointments, similar rate and number of additional procedures but required more and longer re-admissions.
  
  
  CONCLUSIONS
  In our experience, unilateral single stage ADM/I was associated with fewer resources utilised in comparison with two staged TE and LD/TE reconstructions in both complication-free and complicated settings over a 24-month period, despite requiring aesthetic revision in 60.9% of patients. Compared to LD/I, resource utilisation was commensurate in complication-free and complicated settings.
authors.affiliation: Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' Hospital, Westminster Bridge Rd, SE1 7EH London, United Kingdom. Electronic address: ashley.kilchenmann@stud.unibas.ch.
authors.forename: Ashley J R
authors.initials: AJ
authors.lastname: Kilchenmann
authors.affiliation: Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' Hospital, Westminster Bridge Rd, SE1 7EH London, United Kingdom.
authors.forename: Alessia M
authors.initials: AM
authors.lastname: Lardi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' Hospital, Westminster Bridge Rd, SE1 7EH London, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Ho-Asjoe
authors.affiliation: Premier Research Germany Ltd., Europaplatz 5, 64293 Darmstadt, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Junge
authors.affiliation: Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' Hospital, Westminster Bridge Rd, SE1 7EH London, United Kingdom.
authors.forename: Jian
authors.initials: J
authors.lastname: Farhadi
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D019928:Breast Implantation / Q000379:methods*; D001943:Breast Neoplasms / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D010359:Patient Readmission / Q000706:statistics & numerical data; D065286:Prophylactic Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps; D015625:Tissue Expansion Devices
keywords: Acellular dermal matrix; Breast reconstruction; Health-care analysis; Resource utilisation