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Impact of availability of immediate breast reconstruction on bilateral mastectomy rates for breast cancer across the United States: data from the nationwide inpatient sample.
Ann Surg Oncol 2014; 21(10):3290-6AS

Abstract

BACKGROUND

Availability of immediate breast reconstruction (IBR) varies among institutions, yet the impact of IBR availability on the rates of bilateral mastectomy (BM) versus unilateral mastectomy (UM) for breast cancer is unknown.

METHODS

From the 2002 to 2010 Nationwide Inpatient Sample, we identified women with breast cancer undergoing UM or BM with and without IBR using ICD-9 codes. Hospitals were classified as performing IBR if at least one hospitalization included both mastectomy and reconstruction and then by IBR volume. Statistical comparisons utilized Chi square tests, tests for trend, and multivariable logistic regression.

RESULTS

We identified 130,420 women undergoing UM (76.9 %) or BM (23.1 %) for breast cancer. Of 6,579 hospitals, 3,358 (51.0 %) performed no IBRs, while in the remaining 3,221 hospitals, 1 to 638 IBRs were performed per year. Large, teaching, urban, and Northeastern hospitals were more likely to have higher IBR volumes. BM rates were significantly higher in patients treated at those hospitals with higher IBR volumes, from 33.1 % at hospitals performing ≥24 IBRs per year to 9.0 % at hospitals without IBR (p < 0.001). Upon adjusted analysis, patients who elected BM were more likely to be seen at hospitals performing ≥24 IBRs per year (odds ratio 1.69 vs. UM, p < 0.001).

CONCLUSIONS

In this analysis of national data, BM rates were higher in hospitals where IBR was available, suggesting a significant influence of institutional factors on treatment options for breast cancer patients. Efforts are needed to ensure patients have access to IBR when desired and to better understand the reasons for hospital variation in BM rates.

Authors+Show Affiliations

Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA, Habermann.elizabeth@mayo.edu.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25052247

Citation

Habermann, Elizabeth B., et al. "Impact of Availability of Immediate Breast Reconstruction On Bilateral Mastectomy Rates for Breast Cancer Across the United States: Data From the Nationwide Inpatient Sample." Annals of Surgical Oncology, vol. 21, no. 10, 2014, pp. 3290-6.
Habermann EB, Thomsen KM, Hieken TJ, et al. Impact of availability of immediate breast reconstruction on bilateral mastectomy rates for breast cancer across the United States: data from the nationwide inpatient sample. Ann Surg Oncol. 2014;21(10):3290-6.
Habermann, E. B., Thomsen, K. M., Hieken, T. J., & Boughey, J. C. (2014). Impact of availability of immediate breast reconstruction on bilateral mastectomy rates for breast cancer across the United States: data from the nationwide inpatient sample. Annals of Surgical Oncology, 21(10), pp. 3290-6. doi:10.1245/s10434-014-3924-y.
Habermann EB, et al. Impact of Availability of Immediate Breast Reconstruction On Bilateral Mastectomy Rates for Breast Cancer Across the United States: Data From the Nationwide Inpatient Sample. Ann Surg Oncol. 2014;21(10):3290-6. PubMed PMID: 25052247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of availability of immediate breast reconstruction on bilateral mastectomy rates for breast cancer across the United States: data from the nationwide inpatient sample. AU - Habermann,Elizabeth B, AU - Thomsen,Kristine M, AU - Hieken,Tina J, AU - Boughey,Judy C, Y1 - 2014/07/23/ PY - 2014/04/14/received PY - 2014/7/24/entrez PY - 2014/7/24/pubmed PY - 2015/6/17/medline SP - 3290 EP - 6 JF - Annals of surgical oncology JO - Ann. Surg. Oncol. VL - 21 IS - 10 N2 - BACKGROUND: Availability of immediate breast reconstruction (IBR) varies among institutions, yet the impact of IBR availability on the rates of bilateral mastectomy (BM) versus unilateral mastectomy (UM) for breast cancer is unknown. METHODS: From the 2002 to 2010 Nationwide Inpatient Sample, we identified women with breast cancer undergoing UM or BM with and without IBR using ICD-9 codes. Hospitals were classified as performing IBR if at least one hospitalization included both mastectomy and reconstruction and then by IBR volume. Statistical comparisons utilized Chi square tests, tests for trend, and multivariable logistic regression. RESULTS: We identified 130,420 women undergoing UM (76.9 %) or BM (23.1 %) for breast cancer. Of 6,579 hospitals, 3,358 (51.0 %) performed no IBRs, while in the remaining 3,221 hospitals, 1 to 638 IBRs were performed per year. Large, teaching, urban, and Northeastern hospitals were more likely to have higher IBR volumes. BM rates were significantly higher in patients treated at those hospitals with higher IBR volumes, from 33.1 % at hospitals performing ≥24 IBRs per year to 9.0 % at hospitals without IBR (p < 0.001). Upon adjusted analysis, patients who elected BM were more likely to be seen at hospitals performing ≥24 IBRs per year (odds ratio 1.69 vs. UM, p < 0.001). CONCLUSIONS: In this analysis of national data, BM rates were higher in hospitals where IBR was available, suggesting a significant influence of institutional factors on treatment options for breast cancer patients. Efforts are needed to ensure patients have access to IBR when desired and to better understand the reasons for hospital variation in BM rates. SN - 1534-4681 UR - https://www.unboundmedicine.com/medline/citation/25052247/Impact_of_availability_of_immediate_breast_reconstruction_on_bilateral_mastectomy_rates_for_breast_cancer_across_the_United_States:_data_from_the_nationwide_inpatient_sample_ L2 - https://dx.doi.org/10.1245/s10434-014-3924-y DB - PRIME DP - Unbound Medicine ER -