PURPOSE:Despite equivalent oncologic survivorship, U.S. lumpectomy rates previously declined in favor of more aggressive surgical options such as mastectomy, often performed in conjunction with a contralateral prophylactic mastectomy (CPM) with or without reconstruction. Using three national datasets, this study evaluates longitudinal trends in lumpectomy/mastectomy, CPM, and breast reconstruction rates, determining characteristics most associated with current surgical practice.
METHODS:Trends in lumpectomy, mastectomy, and reconstruction rates were evaluated using the NSQIP, SEER, and NCDB databases from 2005-2017, further examining mastectomy with a focus on CPM. Longitudinal trends were analyzed with Cochran-Armitage Trend tests and Poisson regression. Multivariate logistic regression using NCDB identified predictors of the described surgeries.
RESULTS:We analyzed 3,467,645 female surgical breast cancer patients. Lumpectomy rates reached a nadir between 2010-2013, with a significant increase thereafter (NSQIP: +1%/year; SEER +1.6%/year; NCDB: +1.6%/year, all p<0.001). Concurrently there was corresponding decrease in mastectomy rates. Both CPM and reconstruction rates increased significantly from 2005-2013 (p<0.001), but have since stabilized.
CONCLUSION:Longitudinal data demonstrate a reversal of prior trends which favored more aggressive surgical management of breast cancer. This is also the first evidence of level breast reconstruction rates since passage of the WHCRA. Further research is required to understand factors driving these recent practice changes and associated impact on patient reported outcomes.
A total of 7,311,656 patients were identified with isolated LE trauma in both databases; 25,818 received amputation (88.7%) while 3,304 underwent FFR (11.3%). Out of 130,610 patients treated at the top volume quartile of centers performing FFR, 806 received FFR (36%) while 1,422 received amputation (64%). Annual rates of amputation decreased from 2015-2019 (P<0.001) while FFRs increased over the decade (P=0.001). Patients who were in higher income percentiles and treated at large teaching hospitals were more likely to receive FFR, while older, publicly insured, multimorbid, and more severely injured patients were less likely. Patients with FFR were not associated with increased overall costs
PSRC 2023 Abstracts or use of radiation therapy between groups. On univariate regression, compared to thin ADM, thick ADM was significantly associated with a greater incidence of seroma (25% versus 7% in the thin group, p=0.03). There was no difference in rates of hematoma, implant flipping, explantation or reconstructive failure between groups.
CONCLUSION:Thick ADM is associated with a greater incidence of seroma in two-stage implant-based breast reconstruction.
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