BCS: Age, Race, Insurance, Location Affect Postmastectomy Reconstruction Rate
The retrospective study used the Nationwide Inpatient Sample, an all-payer stratified statistical sample of US hospital discharges, to identify 14,986 women who underwent mastectomies in 2008. Socioeconomic and geographic features were compared and analyses performed to differentiate among three groups: patients without reconstruction, patients who underwent breast implant/tissue expander reconstruction, and patients with advanced reconstruction techniques, including free or pedicled flaps, stated Barbara A. Wexelman, MD, St. Luke's Roosevelt Hospital, New York, NY, and colleagues.
They found that 63% of women had no reconstruction, 25.3%, breast implant/tissue expander reconstruction, and 12%, advanced reconstruction.
Women who had breast implant/tissue expander or advanced reconstruction were found to be younger, 51.3 years and 51.1 years, respectively, compared with those who did not undergo reconstruction, 64.9 years (P<0.001). These two groups also had fewer chronic conditions, 2.60 and 2.54, compared with 3.85 for the nonreconstruction group, and higher mean hospital charges, $42,850 and $48,680 vs. $22,300, respectively (all P<0.001). Length of stay was longest for patients undergoing advanced reconstruction techniques, 3.62 days, compared with 2.02 days for the nonreconstruction group and 1.90 days for the breast implant/tissue expander reconstruction group (P<0.001).
Caucasians were disproportionately more likely to undergo both breast implant/tissue expander and advanced reconstruction compared with black and Hispanic women, Dr. Wexelman noted.
A total of 81.1% of patients who underwent advanced reconstruction techniques had private insurance, as did 80.1% of those who underwent breast implant/tissue expander and advanced reconstruction; 35.2% of those who did not undergo reconstruction had private insurance and were more likely to be covered by Medicare and Medicaid.
Those who had reconstructions were more likely to live in zip codes with higher average incomes and to live in or near a city with a population of 1 million or more. States identified as having the highest rates of advanced reconstruction techniques were New Hampshire (52.9%), Kansas (22.6%), New York (20.9%), and New Jersey (20.0%), the investigators reported.
“It is not known whether these women presented with more advanced cancers, which may account for the lack of reconstruction," noted Deanna J. Attai, MD, of the Center for Breast Care, Inc., Burbank, CA. “It is also not known if patients who underwent mastectomy without reconstruction were given the option of reconstruction and declined. However, it is clear that more research is needed to determine the root cause of disparities in access to care and to determine how to best educate women about their options.”