A Cross-Sectional Study of Variations in Reimbursement for Breast Reconstruction

Odom, Elizabeth B.; Schmidt, Alexandra; Myckatyn, Terence M.; Buck, Donald W.

doi:10.1097/sap.0000000000001228

Cited by 41 publications

(36 citation statements)

References 20 publications

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“…5 Hospital and system-level considerations, such as geographic access to academic centers offering reconstruction, type of hospital, and density of plastic surgeons, have also been found to contribute to differences in reconstruction rates. 22,24,25 Finally, provider-level considerations, including initial referral to a plastic surgeon and discussions about reconstruction from both surgical oncologists and plastic surgeons, have been found to vary by race, ethnicity, and insurance status, 7,20,26 and could contribute to our reported lower rates of reconstruction among minorities and the uninsured.…”

Section: Discussionmentioning

confidence: 84%

“…Our study found that black and Hispanic women were significantly less likely to undergo reconstruction even after adjusting for known covariates, a trend that has been shown in studies using institutional data 10,17 ; earlier analyses of the Surveillance, Epidemiology, and End Results database 5,9,14,18 ; and both the National Surgical Quality Improvement Program and Nationwide Inpatient Sample. 6,19 Insurance status alone likely does not explain racial differences in reconstruction rates: although a higher proportion of minority patients have public insurance or lack insurance, limiting access to plastic surgeons and precluding some surgeons from offering reconstruction, 20 minorities remain significantly less likely to undergo reconstruction even after controlling for insurance type. 8,13,19,21,22 Other socioeconomic barriers likely also contribute to this trend.…”

Section: Discussionmentioning

confidence: 99%

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Decline in Racial Disparities in Postmastectomy Breast Reconstruction: A Surveillance, Epidemiology, and End Results Analysis from 1998 to 2014

Sergesketter

Thomas

Lane

et al. 2019

Plastic &Amp; Reconstructive Surgery

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Background: Despite increasing emphasis on reducing racial disparities in breast cancer care in the United States, it remains unknown whether access to breast reconstruction has improved over time. The authors characterized contemporary patterns of breast reconstruction by race and ethnicity. Methods: The Surveillance, Epidemiology, and End Results database was used to identify women undergoing mastectomy for stage 0 to III breast cancer from 1998 to 2014. Multivariable logistic regression was used to estimate the association of demographic factors with likelihood of postmastectomy reconstruction. Multivariable logistic regression was used to predict reconstruction subtype. Patients undergoing reconstruction were grouped by diagnosis year to assess change in the population over time by race and ethnicity. Results: Of 346,418 patients, 21.8 percent underwent immediate reconstruction. Non-Hispanic black race (OR, 0.71) and Hispanic ethnicity (OR, 0.63) were associated with a decreased likelihood of reconstruction (all p < 0.001). Race was predictive of reconstruction type, with non-Hispanic black (OR, 1.52) and Hispanic women (OR, 1.22) more likely to undergo autologous versus implant-based reconstruction (p < 0.001). Although rates of reconstruction increased over time across all races, non-Hispanic black and Hispanic patients had a higher adjusted per-year increase in rate of reconstruction compared with non-Hispanic white patients (interaction p < 0.001). Conclusions: Rates of postmastectomy reconstruction have increased more quickly over time for minority women compared with white women, suggesting that racial disparities in breast reconstruction may be improving. However, race continues to be associated with differences in

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Decline in Racial Disparities in Postmastectomy Breast Reconstruction: A Surveillance, Epidemiology, and End Results Analysis from 1998 to 2014

Sergesketter

Thomas

Lane

et al. 2019

Plastic &Amp; Reconstructive Surgery

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“…Though lymphedema surgery is typically reimbursed, Medicare has been linked to disparities in access to other covered reconstructive procedures such as breast reconstruction. 25,26 Arguments could be made that Medicare reimburses reconstructive procedures at lower rates than private insurers, which may preclude some hospitals from offering these procedures. However, in our cohort, all patients were offered surgery.…”

Section: Sociodemographic Factors May Impact Lymphedema-related Qualimentioning

confidence: 99%

Surgical versus Nonsurgical Management of Postmastectomy Lymphedema: A Prospective Quality of Life Investigation

Darrach

Yesantharao

Persing

et al. 2020

J Reconstr Microsurg

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Abstract Background Postmastectomy secondary lymphedema can cause substantial morbidity. However, few studies have investigated longitudinal quality of life (QoL) outcomes in patients with postmastectomy lymphedema, especially with regard to surgical versus nonoperative management. This study prospectively investigated QoL in surgically versus nonsurgically managed patients with postmastectomy upper extremity lymphedema. Methods This was a longitudinal cohort study of breast cancer-related lymphedema patients at a single institution, between February 2017 and January 2020. Lymphedema Quality of Life Instrument (LyQLI) and RAND-36 QoL instrument were used. Mann–Whitney U and Fisher's exact tests were used for descriptive statistics. Wilcoxon's signed-rank testing and linear modeling were used to analyze longitudinal changes in QoL. Results Thirty-two lymphedema patients were recruited to the study (20 surgical and 12 nonsurgical). Surgical and nonsurgical cohorts did not significantly differ in clinical/demographic characteristics or baseline QoL scores, but at the 12-month time point surgical patients had significantly greater LyQLI overall health scores than nonsurgical patients (79.3 vs. 58.3, p = 0.02), as well as higher composite RAND-36 physical (68.5 vs. 38.3, p = 0.04), and mental (77.0 vs. 52.7, p = 0.02) scores. Furthermore, LyQLI overall health scores significantly improved over time in surgical patients (60.0 at baseline vs. 79.3 at 12 months, p = 0.04). Besides surgical treatment, race, and age were also found to significantly impact QoL on multivariable analysis. Conclusion Our results suggest that when compared with nonoperative management, surgery improved QoL for chronic, secondary upper extremity lymphedema patients within 12-month postoperatively. Our results also suggested that insurance status may have influenced decisions to undergo lymphedema surgery. Further study is needed to investigate the various sociodemographic factors that were also found to impact QoL outcomes in these lymphedema patients.

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“…The ability to reliably perform a DIEP flap is a marketable skill, not only in academic centers but also in private practice. As the breast reconstruction volume has increased due to increasing public awareness, insurance coverage, and mastectomy rates in the past decades, 20 breast reconstruction patients are abundant as patients for graduating microsurgeons. Graduates can market their microsurgical breast reconstructive skills in a variety of settings, perhaps even being the first to bring microsurgical breast reconstruction to a practice or community hospital.…”

Section: Discussionmentioning

confidence: 99%

The Ideal Microsurgery Fellowship: A Survey of Fellows and Fellowship Directors

Reghunathan

Zaldana-Flynn

Rose

et al. 2020

J Reconstr Microsurg

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Background Although microsurgery fellowships have existed since the 1980s, there is no established curriculum. Microsurgery fellowships vary greatly in clinical caseload, case diversity, and training resources, and there is no consensus on the appropriate composition of a microsurgery fellowship. This study surveys fellowship directors (FD) and recent microsurgery fellows (MFs), graduates, to describe the ideal microsurgery fellowship program. Methods A 15-item questionnaire was sent to 38 FDs and 90 recent microsurgery fellowship graduates. This questionnaire addressed program attributes, case volumes and compositions, ideal experiences, and time allocation to different fellowship experiences. Data were analyzed using descriptive statistics, t-tests, and Chi-squared tests. Results The FD and MF surveys had a response rate of 47 and 49%, respectively. Both MF and FD agreed that exposure to microsurgical breast reconstruction is the most important characteristic of a microsurgery fellowship (p = 0.94). MF ranked replantation and supermicro/lymphatic surgery as the next most important microsurgical cases, while FD ranked the anterolateral thigh (ALT) flap and free fibula flap (p < 0.001). Both agreed that revisional surgery after microsurgical reconstruction is a very valuable fellowship experience (p = 0.679). Both agreed that 1 day of clinic a week is sufficient. Conclusion Microsurgical training programs vary in quality and resources. The ideal microsurgery fellowship prioritized breast reconstruction, head and neck reconstruction, and lower extremity reconstruction. Although microsurgical technical expertise is important, a fellowship should also train in revisional surgeries and clinical decision making.

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A Cross-Sectional Study of Variations in Reimbursement for Breast Reconstruction

Cited by 41 publications

References 20 publications

Decline in Racial Disparities in Postmastectomy Breast Reconstruction: A Surveillance, Epidemiology, and End Results Analysis from 1998 to 2014

Decline in Racial Disparities in Postmastectomy Breast Reconstruction: A Surveillance, Epidemiology, and End Results Analysis from 1998 to 2014

Surgical versus Nonsurgical Management of Postmastectomy Lymphedema: A Prospective Quality of Life Investigation

The Ideal Microsurgery Fellowship: A Survey of Fellows and Fellowship Directors

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