Nationwide cost variation for lower extremity flap reconstruction

Background With increased attention around a value-based healthcare system, continuous emphasis has been made on the evaluation of hospital volume and its association with cost and outcomes. The aim of this study was to analyze nationwide cost variation and outcomes in relation to hospital case volume and geographical location for lower extremity flap reconstruction. Methods A retrospective analysis of the National Inpatient Sample database was performed. Participants were patients who were admitted with the diagnosis of lower extremity trauma and underwent flap reconstruction, inclusive of pedicled and free flaps. The primary variable of interest was hospital cost. Additionally, we evaluated patient demographics, hospital characteristics, and outcomes of postoperative complications and length of stay. Results A total of 1200 patients were extracted. Median hospital cost for each procedure was $67,845.09. High volume hospitals had significantly lower costs than medium and low volume hospitals ( p = 0.011), with median cost being $56,498.77. On regression analysis, hospital volume was not independently associated with increased hospital costs; however, notable factors identified included surgical and systemic complications, as well as longer length of stay. Of note, high volume hospitals were also associated with significantly fewer surgical complications ( p = 0.002) and shorter length of stay ( p < 0.001). The Western region was also independently associated with increased hospital costs. Conclusions High hospital case volume appears to be indirectly associated with decreased hospital costs. The results of this study highlight the constant need to improve cost efficiency and reduce excess utilization costs while maintaining optimal patient outcomes. Level of evidence: Level IV, risk/prognostic study.