The Optimal Length of Stay after Microvascular Breast Reconstruction: A Cost-Utility Analysis

Background: Length of stay can have a large impact on overall surgical costs. Several studies have demonstrated that a shortened length of stay is safe and effective after microvascular breast reconstruction. The optimal length of stay from a cost-utility perspective is not known. Methods: The authors used a decision tree model to evaluate the cost-utility, from the perspective of the hospital, of a variety of length-of-stay strategies. Health state probabilities were estimated from an institutional chart review. Expected costs and quality-adjusted life-years were assessed using Monte Carlo simulation and sensitivity analyses. Results: Over a 10-year period, the authors' overall flap loss and take-back rates were 1.6 percent and 4.9 percent, respectively. After rollback, a 3-day length of stay was identified as the most cost-effective strategy, with an expected cost of $41,680.19 and an expected health utility of 25.68 quality-adjusted life-years. Monte Carlo sensitivity analysis confirmed that discharge on postoperative day 3 was the most cost-effective strategy in the majority of simulations when the willingness-to-pay threshold varied from $50,000 to $130,000 per quality-adjusted life-year gained. Conclusion: This cost-utility analysis suggests that a 3-day length of stay is the most cost-effective strategy after microvascular breast reconstruction.