title: A comparison of long-term cost and clinical outcomes between the two-stage sequence expander/prosthesis and autologous deep inferior epigastric flap methods for breast reconstruction in a public hospital.
abstract: BACKGROUND
  Postmastectomy breast reconstruction involves the use of large amounts of hospital resources. This study provides comparative data on the clinical results and long-term economic costs of two methods of breast reconstruction in a public hospital.
  
  
  METHODS
  A prospective cohort study was performed to evaluate the costs incurred by delayed unilateral breast reconstruction performed using either the two-stage sequence expander/prosthesis (E-P) or autologous deep inferior epigastric flap (DIEP) method during 2005-2013 in 134 patients. The major evaluated variables included previous clinical records, history of radiotherapy, and number of surgical procedures. Total costs accounted for both direct intra- and extra-hospital costs derived from the initial reconstruction and those resulting from associated reoperations due to aesthetic retouches and/or complications.
  
  
  RESULTS
  Patients undergoing E-P reconstruction required a higher number of surgery sessions to complete the reconstruction (3.07 vs. 2.32, p < 0.001) and showed higher rates of surgery-related complications (40.29% vs. 32.82%). No statistically significant differences were found between the two surgical methods in terms of total costs (€18857.77 DIEP vs. €20502.08 E-P; p = 0.89). In the E-P cohort, active smoking and history of radiotherapy were statistically significant risk factors of complications. In the DIEP group, only active smoking was significantly associated with complications.
  
  
  CONCLUSIONS
  Compared to the E-P method, breast reconstruction using the DIEP method is more cost-effective and involves fewer serious complications that result in reconstruction failure or undesirable aesthetic results. E-P reconstruction presents a higher number of complications that may cause surgical failure or poor outcomes.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Virgen del Rocio University Hospital, Seville, Spain. Electronic address: alagaresborrego@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Lagares-Borrego
authors.affiliation: Department of Plastic and Reconstructive Surgery, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Gacto-Sanchez
authors.affiliation: Department of Surgery, University of Seville, School of Medicine, Manuel Siurot Avenue s/n., 41013, Seville, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Infante-Cossio
authors.affiliation: Department of Plastic and Reconstructive Surgery, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Barrera-Pulido
authors.affiliation: Department of Plastic and Reconstructive Surgery, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Sicilia-Castro
authors.affiliation: Department of Plastic and Reconstructive Surgery, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Gomez-Cia
mesh_terms: D018427:Breast Implants / Q000191:economics*; D001943:Breast Neoplasms / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D016462:Mammaplasty / Q000191:economics / Q000295:instrumentation*; D008408:Mastectomy; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D017568:Rectus Abdominis / Q000637:transplantation*; D013030:Spain; D013524:Surgical Flaps; D013997:Time Factors; D015625:Tissue Expansion Devices / Q000191:economics*; D014182:Transplantation, Autologous
keywords: Breast implants; Breast reconstruction; Complications; Cost analysis; DIEP; Deep inferior epigastric artery perforator flap