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Patterns of immediate breast reconstruction in New South Wales, Australia: a population-based study.
ANZ J Surg 2019AJ

Abstract

BACKGROUND

The rate of immediate breast reconstruction (IBR) following mastectomy for breast cancer in Australia is low and varies between regions. To date, no previous Australian studies have examined IBR rates between all hospitals within a particular jurisdiction, despite hospitals being an important known contributor to variation in IBR rates in other countries.

METHODS

We used cross-classified random-effects logistic regression models to examine the inter-hospital variation in IBR rates by using data on 7961 women who underwent therapeutic mastectomy procedures in New South Wales (NSW) between January 2012 and June 2015. We derived IBR rates by patient-, residential neighbourhood- and hospital-related factors and investigated the underlying drivers for the variation in IBR.

RESULTS

We estimated the mean IBR rate across all hospitals performing mastectomy to be 17.1% (95% Bayesian credible interval (CrI) 12.1-23.1%) and observed wide inter-hospital variation in IBR (variance 4.337, CrI 2.634-6.889). Older women, those born in Asian countries (odds ratio (OR) 0.5, CrI 0.4-0.6), residing in neighbourhoods with lower socioeconomic status (OR 0.7, CrI 0.5-0.8 for the most disadvantaged), and who underwent surgery in public hospitals (OR 0.4, CrI 0.1-1.0) were significantly less likely to have IBR. Women residing in non-metropolitan areas and attending non-metropolitan hospitals were significantly less likely to undergo IBR than their metropolitan counterparts attending metropolitan hospitals.

CONCLUSION

Wide inter-hospital variation raises concerns about potential inequities in access to IBR services and unmet demand in certain areas of NSW. Explaining the underlying drivers for IBR variation is the first step in identifying policy solutions to redress the issue.

Authors+Show Affiliations

Menzies Centre for Health Policy, Sydney School of Public Health, Charles Perkins Centre D17, The University of Sydney, Sydney, New South Wales, Australia. Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia. Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia.Centre for Big Data Research in Health, The University of New South Wales, Sydney, New South Wales, Australia.Menzies Centre for Health Policy, Sydney School of Public Health, Charles Perkins Centre D17, The University of Sydney, Sydney, New South Wales, Australia.Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia. Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia. Breast and Melanoma Surgery Units, The Mater Hospital, Sydney, New South Wales, Australia. Breast and Melanoma Surgery Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.Menzies Centre for Health Policy, Sydney School of Public Health, Charles Perkins Centre D17, The University of Sydney, Sydney, New South Wales, Australia. Centre for Big Data Research in Health, The University of New South Wales, Sydney, New South Wales, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31418524

Citation

Feng, Yingyu, et al. "Patterns of Immediate Breast Reconstruction in New South Wales, Australia: a Population-based Study." ANZ Journal of Surgery, 2019.
Feng Y, Flitcroft K, van Leeuwen MT, et al. Patterns of immediate breast reconstruction in New South Wales, Australia: a population-based study. ANZ J Surg. 2019.
Feng, Y., Flitcroft, K., van Leeuwen, M. T., Elshaug, A. G., Spillane, A., & Pearson, S. A. (2019). Patterns of immediate breast reconstruction in New South Wales, Australia: a population-based study. ANZ Journal of Surgery, doi:10.1111/ans.15381.
Feng Y, et al. Patterns of Immediate Breast Reconstruction in New South Wales, Australia: a Population-based Study. ANZ J Surg. 2019 Aug 16; PubMed PMID: 31418524.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patterns of immediate breast reconstruction in New South Wales, Australia: a population-based study. AU - Feng,Yingyu, AU - Flitcroft,Kathy, AU - van Leeuwen,Marina T, AU - Elshaug,Adam G, AU - Spillane,Andrew, AU - Pearson,Sallie-Anne, Y1 - 2019/08/16/ PY - 2018/12/12/received PY - 2019/06/21/revised PY - 2019/06/24/accepted PY - 2019/8/17/entrez KW - breast cancer KW - breast reconstruction KW - cohort study KW - health services accessibility KW - multilevel analysis JF - ANZ journal of surgery JO - ANZ J Surg N2 - BACKGROUND: The rate of immediate breast reconstruction (IBR) following mastectomy for breast cancer in Australia is low and varies between regions. To date, no previous Australian studies have examined IBR rates between all hospitals within a particular jurisdiction, despite hospitals being an important known contributor to variation in IBR rates in other countries. METHODS: We used cross-classified random-effects logistic regression models to examine the inter-hospital variation in IBR rates by using data on 7961 women who underwent therapeutic mastectomy procedures in New South Wales (NSW) between January 2012 and June 2015. We derived IBR rates by patient-, residential neighbourhood- and hospital-related factors and investigated the underlying drivers for the variation in IBR. RESULTS: We estimated the mean IBR rate across all hospitals performing mastectomy to be 17.1% (95% Bayesian credible interval (CrI) 12.1-23.1%) and observed wide inter-hospital variation in IBR (variance 4.337, CrI 2.634-6.889). Older women, those born in Asian countries (odds ratio (OR) 0.5, CrI 0.4-0.6), residing in neighbourhoods with lower socioeconomic status (OR 0.7, CrI 0.5-0.8 for the most disadvantaged), and who underwent surgery in public hospitals (OR 0.4, CrI 0.1-1.0) were significantly less likely to have IBR. Women residing in non-metropolitan areas and attending non-metropolitan hospitals were significantly less likely to undergo IBR than their metropolitan counterparts attending metropolitan hospitals. CONCLUSION: Wide inter-hospital variation raises concerns about potential inequities in access to IBR services and unmet demand in certain areas of NSW. Explaining the underlying drivers for IBR variation is the first step in identifying policy solutions to redress the issue. SN - 1445-2197 UR - https://www.unboundmedicine.com/medline/citation/31418524/Patterns_of_immediate_breast_reconstruction_in_New_South_Wales,_Australia:_a_population-based_study L2 - https://doi.org/10.1111/ans.15381 DB - PRIME DP - Unbound Medicine ER -