ABSTRACT
BACKGROUND: The positive benefits of immediate prosthesis breast reconstruction (IPBR) are incontrovertible. During the COVID-19 pandemic, health care resources became scarce. The implementation of outpatient immediate prosthesis breast reconstruction (OIPBR) can improve the efficiency of medical care and reduce viral exposure. Very few studies have focused on OIPBR and this study aimed to fill this gap by evaluating outcomes of OIPBR compared with traditional hospitalization IPBR (THIPBR) in terms of complications and quality of life. MATERIAL AND METHODS: The study enrolled patients undergoing IPBR at Tianjin Medical University Cancer Institute and Hospital between January 1, 2020, and September 30, 2021. Outcomes were defined as postoperative complications and quality of life before reconstruction and at 3-month follow-up. Quality of life was assessed by BREAST-Q questionnaire. Inverse probability of treatment weighting and propensity score matching (PSM) were applied to adjust for confounders. RESULTS: A total of 135 patients were enrolled, including 110 with THIPBR and 25 with OIPBR. After matching, baseline characteristics were well balanced. Patients with OIPBR had lower rates of lymphedema on the surgery side (p = 0.041) and readmission (p = 0.040) than patients with THIPBR. No statistically significant differences in the quality of life metrics of psychosocial well-being, sexual well-being, satisfaction with breast and physical well-being of the chest were found between the two groups. CONCLUSION: OIPBR is a safe and efficient alternative to THIBPR during the COVID-19 pandemic. It is recommended when medical conditions allow to conserve medical resources. Accelerated technical training for the performance of OIPBR at the hospital level should be expedited. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
ABSTRACT
This paper aims to investigate the impact of the introduction of the long-haul low cost carrier in the North Atlantic market to present the competitive situation before the COVID-19. There are a number of challenges in estimating the incremental effect of LH LCC. Therefore, several strategies were taken. Firstly, a difference in differences estimation and propensity score matched methods were employed using six major routes in the North Atlantic market with IATA's ticket sale data from January 2015 to December 2019; a granulated data to present the characteristics of flight and economy class fares. The outcomes indicate that a 17.2-20.6% fare reduction in average on the routes where Norwegian operated during 2015 and 2019 after Norwegian's entry, compared to what it would have happened if they didn't operate. It implies the LH LCC entry lowered fares significantly, and the level of fare competition in the North Atlantic market before the COVID-19 was high. In addition, a certain level of viability as an LH LCC has been implicated. This output can be used for the airline's strategic implication and the policy proposition, particularly when LCC expands the longer routes after the COVID recovery. Frequent and specific (detailed) assessments by market and period are imperative.