Comparative Analysis of 18-Month Outcomes and Costs of Breast Reconstruction Flap Procedures
Bibliographic record
Abstract
BACKGROUND: Data from large-scale studies of breast reconstruction surgery outcomes and downstream costs are lacking. The authors assessed outcomes, patient return rates, and costs across a large, geographically diverse patient population undergoing autologous breast reconstruction. METHODS: Insurance claims for patients undergoing free flap, latissimus dorsi flap, or transverse rectus abdominis myocutaneous (TRAM) flap autologous breast reconstruction were extracted from a U.S. health care database. Claims for an 18-month period after the initial (index) procedure were analyzed to assess episodes of care, complications, breast procedures, and costs. RESULTS: Of 828 patients (274 free flaps, 302 latissimus dorsi flaps, and 252 TRAM flaps), 35 percent experienced postindex complications: incidences related to implant/graft/mesh and hematoma/seroma were highest in the latissimus dorsi arm (19 percent and 6 percent, respectively); the incidence related to breast necrosis was highest in the free flap arm (8 percent); and that related to wound complications was highest in the TRAM arm (6 percent). Returns for complications were 92.7, 84.4, and 115.5 of 100 patients in the free, latissimus dorsi, and TRAM flap arms (p < 0.05, TRAM flap versus other arms), respectively, and 105.5, 116.6, and 87.7 of 100 patients, respectively, for procedures unrelated to complications (p < 0.05, latissimus dorsi versus TRAM flaps). Nearly all patients returned at least once for treatments unrelated to complications. Mean total costs for index surgery plus postindex events were $56,205, $30,783, and $33,380 in the free, latissimus dorsi, and TRAM flap arms, respectively. CONCLUSIONS: Eighteen-month complication and return rates for postindex events were similar across study arms. The frequency of returns and associated cost of procedures unrelated to complications point to the inherently staged nature of autologous breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".