J Reconstr Microsurg 2011; 27(8): 487-494
DOI: 10.1055/s-0031-1284234
© Thieme Medical Publishers

Cost Analysis of Near-Infrared Spectroscopy Tissue Oximetry for Monitoring Autologous Free Tissue Breast Reconstruction

Aaron Pelletier1 , Charles Tseng1 , Shailesh Agarwal1 , Julie Park1 , David Song1
  • 1Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
Further Information

Publication History

Publication Date:
22 July 2011 (online)

ABSTRACT

Free flap monitoring typically requires specialized nursing that can increase medical costs. This study uses near-infrared spectroscopy (NIRS) tissue oximetry to monitor free tissue breast reconstruction. We hypothesize this practice will reduce medical costs by eliminating the need for specialized nursing. From August 2006 to January 2010, women undergoing unilateral free tissue breast reconstruction were enrolled and admitted postoperatively to either the surgical intensive care unit (ICU) or floor. Each underwent continuous monitoring using NIRS tissue oximetry and intermittent clinical examination with surface Doppler ultrasonography. Patient demographics, comorbidities, perioperative details, and financial data were recorded. There were 50 patients studied, all with abdominal-based flaps (25 per group). There were no statistically significant differences in patient demographics, comorbidities, mean flap weight, ischemia time, or length of stay between the ICU and floor groups. Four flaps had vascular complications, all detected by NIRS tissue oximetry. Comparison of hospital costs showed an average reduction of $1937 per patient when monitored on the surgical floor (p = 0.036). NIRS tissue oximetry is a sensitive and reliable monitoring tool, eliminating the need for specialized nursing care. The effect is decreased cost structure and increased hospital contribution margin for autologous free tissue breast reconstruction.

REFERENCES

  • 1 Nahebedian M Y, Momen B, Mason P N. Factors associated with anastomotic failure after microvascular reconstruction of the breast.  Plast Reconstr Surg. 2004;  114 (1) 74-82
  • 2 Smit J M, Acosta R, Zeebregts C J, Liss A G, Anniko M, Hartman E H. Early reintervention of compromised free flaps improves success rate.  Microsurgery. 2007;  27 (7) 612-616
  • 3 Hirigoyen M B, Urken M L, Weinberg H. Free flap monitoring: a review of current practice.  Microsurgery. 1995;  16 (11) 723-726 discussion 727
  • 4 Marini C P, Russo G C, Nathan I M, McNelis J, Jurkiewicz A, Simms H H. Closed vs. open intensive care unit: impact of full-time surgical intensivists.  Intern J Emerg Intens Care Med. 2002;  6 (1)
  • 5 Creech B, Miller S. Evaluation of circulation in skin flaps. In: Grabb W C, Myers M B, eds. Skin Flaps. Boston: Little, Brown; 1975. 21
  • 6 Jones N F. Intraoperative and postoperative monitoring of microsurgical free tissue transfers.  Clin Plast Surg. 1992;  19 (4) 783-797
  • 7 Smit J M, Zeebregts C J, Acosta R, Werker P MN. Advancements in free flap monitoring in the last decade: a critical review.  Plast Reconstr Surg. 2010;  125 (1) 177-185
  • 8 Repez A, Oroszy D, Arnez Z M. Continuous postoperative monitoring of cutaneous free flaps using near infrared spectroscopy.  J Plast Reconstr Aesthet Surg. 2008;  61 (1) 71-77
  • 9 Cai Z G, Zhang J, Zhang J G et al.. Evaluation of near infrared spectroscopy in monitoring postoperative regional tissue oxygen saturation for fibular flaps.  J Plast Reconstr Aesthet Surg. 2008;  61 (3) 289-296
  • 10 Colwell A S, Wright L, Karanas Y. Near-infrared spectroscopy measures tissue oxygenation in free flaps for breast reconstruction.  Plast Reconstr Surg. 2008;  121 (5) 344e-345e
  • 11 Keller A. A new diagnostic algorithm for early prediction of vascular compromise in 208 microsurgical flaps using tissue oxygen saturation measurements.  Ann Plast Surg. 2009;  62 (5) 538-543

David SongM.D. 

Department of Surgery, University of Chicago Medical Center

5841 S. Maryland Avenue, M/C 6035, Chicago, IL 60637

Email: dsong@surgery.bsd.uchicago.edu

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