Coste de la reconstrucción mamaria en la sanidad pública española según la técnica aplicada

Abstract

The aim of this work is an analysis of the cost in the spanish public health system of postmastectomy mammary reconstruction, a usual practice in our hospitals. We are based on theoretical expenses, days of stay and index of complications of those patients who joined the Hospital General Universitario of Alicante between 2008 and 2009 for deferred mammary reconstruction We evaluate190 patients with finished reconstruction, include nippleareola. To compare, they were gathered in 3 groups, according to the technique for breast reconstruction. Group 1:with abdominal flaps DIEP or SIEA; Group 2:with expansor/prosthesis and Group 3: with thoracic flaps and expansor/prosthesis. The costs were studied on the basis of the economic information system of the hospital, bearing cost of the preoperative tests, visits, days of stay, time of operating room, awakening or resuscitation and postsurgical cares and reviews. There were studied 28 patients in Group I, 110 in Group II and 42 in Group III: 24 with latissimus dorsi, 10 with perforators flaps and 8 with local flaps. Ten more patients resolved with other procedures (mammary reduction and / or fat grafting). The costs were higher for Group III of thoracic flaps with expansor/ prosthesis. Reconstruction with abdominal flaps in Group I was slightly higher than in the group with expansor/prosthesis. The average stay in Group I was 6 days, in Group II was 2 days and in Group III was 4 days. The index of major complications was similar in all groups. Most of the cases achieved the aesthetic aim of mammary reconstruction needing 2 surgical procedures. Although number of mammary reconstructions with expansor/prosthesis continues being major and initially this type of reconstruction is lightly cheaper that the one with autologous tissues, this cost will increase in time by the needing of implants exchanges, turning out to be eventually a more expensive reconstruction.