Abstract
INTRODUCTION: Rhytidectomy is one of the most commonly performed cosmetic procedures by plastic surgeons. Increasing attention to the development of a high-value, low-cost healthcare system is a priority of U.S. healthcare policy makers as projections of healthcare costs in the U.S. are shown to be unsustainable. This study aims to analyze specific patient and hospital factors that may augment the marginal charges of the procedure. METHODS: We conducted a retrospective cohort study using the National Inpatient Sample. Our cohort consists of self-pay, elective (non-emergent) patients aged over 18 who underwent rhytidectomy between 2013–2014. Mean marginal cost increase patient characteristics and outcomes were studied. Generalized linear modeling with gamma regression and a log-link function were performed along with estimated marginal means to provide cost estimates. RESULTS: A total of 1,890 self-pay patients underwent rhytidectomy. Median cost was $11,767 with an interquartile range of $8,907 [$6,976 – $15,883]. The largest marginal cost increases were associated with postoperative hematoma ($12,651; CI $8,181-$17,120), West coast region ($7,539; 95% CI $6,412-$8,666) and combined rhinoplasty ($7,824; 95% CI $3,808-$11,840). The two risk factors associated with the generation of highest marginal inpatient costs were smoking ($4,147; 95% CI $2,804-$5,490) and diabetes mellitus ($5,622; 95% CI $3,233-$8,011). High volume hospitals had a decreased cost of -$1,331 (95%CI -$2,032 to -$631). CONCLUSION: Cost variation for inpatient rhytidectomy procedures is dependent on preoperative risk factors (diabetes and smoking), postoperative complications (hematoma) and regional trends (West region). Rhytidectomy surgery is highly centralized and increasing hospital volume significantly decreases costs. Clinicians and hospitals can use this information to discuss the drivers of cost in patients undergoing rhytidectomy.
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