A Nationwide Analysis of the Relationship between Hospital Volume and Outcome for Autologous Breast Reconstruction

Section: Discussionmentioning

confidence: 98%

Assessment of Patient Factors, Surgeons, and Surgeon Teams in Immediate Implant-Based Breast Reconstruction Outcomes

Gfrerer

Mattos

Mastroianni

et al. 2015

“…17 For example, high-volume centers are associated with lower complication rates but are often located in metropolitan centers, resulting in increased travel distance for patients residing in rural areas. 15,18 Greater travel distance creates both direct (e.g., commute cost) and indirect (e.g., time, foregone wages) economic barriers, thereby restricting health care options for many patients. 19 The premise of the current report was to use travel distance as a proxy for measuring the influence of geographic barriers on breast reconstruction rates and methods.…”

Section: Discussionmentioning

confidence: 99%

“…15 These trends were analyzed with Poisson regression. All statistical analyses were performed using Stata 11.0 (StataCorp, College Station, Texas).…”

Section: Methodsmentioning

confidence: 99%

The Impact of Travel Distance on Breast Reconstruction in the United States

Albornoz

Cohen

Razdan

et al. 2016

Self Cite

Background Inadequate access to breast reconstruction was a motivating factor underlying passage of the Women’s Health and Cancer Rights Act. It remains unclear whether all patients interested in breast reconstruction undergo this procedure. The aim of this study was to determine whether geographic disparities are present that limit the rate and method of postmastectomy reconstruction. Methods Travel distance in miles between the patient’s residence and the hospital reporting the case was used as a quantitative measure of geographic disparities. The American College of Surgeons National Cancer Database was queried for mastectomy with or without reconstruction performed from 1998 to 2011. Reconstructive procedures were categorized as implant or autologous techniques. Standard statistical tests including linear regression were performed. Results Patients who underwent breast reconstruction had to travel farther than those who had mastectomy alone (p < 0.01). A linear correlation was demonstrated between travel distance and reconstruction rates (p < 0.01). The mean distances traveled by patients who underwent reconstruction at community, comprehensive community, or academic programs were 10.3, 19.9, and 26.2 miles, respectively (p < 0.01). Reconstruction rates were significantly greater at academic programs. Patients traveled farther to undergo autologous compared with prosthetic reconstruction. Conclusions Although greater patient awareness and insurance coverage have contributed to increased breast reconstruction rates in the United States, the presence of geographic barriers suggests an unmet need. Academic programs have the greatest reconstruction rates, but are located farther from patients’ residences. Increasing the number of plastics surgeons, especially in community centers, would be one method of addressing this inequality.

“…These databases have been used to explore practice patterns, healthcare utilization, and access to care for many plastic surgery-related procedures and diagnoses. For example, using the NIS database, Albornoz et al 13 found that higher-volume autologous breast reconstruction centers had lower complication rates than lower volume centers. Squiteri et al 14 found racial and insurancebased disparities in pediatric replantation rates using the KID database.…”

Section: Healthcare Cost and Utilization Projectmentioning

confidence: 98%

“…Data not available to nonaccredited facilities. 13 To participate, they must be members of Children's Hospital Association. Children's Hospital Association membership and Pediatric Health Information System access require separate, annual fees.…”

Section: Attributes Of Large Administrative Databasesmentioning

confidence: 99%

So You Have a Research Idea

Adkinson

Casale

Kim

et al. 2016

Plastic surgery research using large databases has increased dramatically over the past 20 years. With the magnitude and breadth of information available in these databases, researchers are able to more easily answer a wide variety of research questions. This study sought to provide a comprehensive comparative analysis of the relevant databases for plastic surgery research. Database information, data collection methods, acquisition details, and variable availability were collected for 19 large databases. Examples of potential future research utility were ascribed to each database based on this comprehensive analysis. With a greater understanding of the content, strengths, and limitations of these databases, researchers will be better equipped to select the most appropriate database to answer a specific research question.