Abstract 184: The Effect Of Insurance Payer Type On Outcomes And Readmission Rates In Patients Undergoing Breast Reconstruction

Márquez, J. Martín; Makadia, Aatman; Zlatopolsky, Aaron; Hou, Wei; Hajagos, Janos; Khan, Sami U.

doi:10.1097/01.gox.0000667792.74020.ac

Cited by 1 publication

(2 citation statements)

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“…31 In implant- and autologous-based breast reconstruction, patients under Medicaid and Medicare are more likely to develop infections, cellulitis, and tissue necrosis than those who are commercially insured. 32 In our focused examination of DIEP patients, we found that the overall presence of complications did not differ by payer type, but we did find that total flap loss and wound dehiscence were significantly different. Notably, Medicaid patients had the highest and commercial patients had the lowest rates of flap loss.…”

Section: Discussionmentioning

confidence: 61%

“…Pairwise analysis indicated that there were significant differences between commercial (48 [36,63]) and Medicare (43 [31,59]) patients at 6 months (p ¼ 0.019), meeting the MCID of 4. The difference was also observed at 1 year, in which commercially insured patients scored 4 points higher on Sexual Well-being than Medicare patients (52 [39,66] vs. 48 [32,63], p ¼ 0.045).…”

Section: Sexual Well-being Analysismentioning

confidence: 81%

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Social Determinants of Health and Patient-reported Outcomes Following Autologous Breast Reconstruction, Using Insurance as a Proxy

Plotsker,

Graziano,

Kim

et al. 2024

J Reconstr Microsurg

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Introduction: Insurance type can serve as a surrogate marker for social determinants of health and can influence many aspects of the breast reconstruction experience. We aimed to examine the impact of insurance coverage on patients reported outcomes with the BREAST-Q in patients receiving deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. Methods: We retrospectively examined patients who received DIEP flaps at our institution from 2010-2019. Patients were divided into categories by insurance: commercial, Medicaid, or Medicare. Demographic factors, surgical factors, and complication data were recorded. Descriptive statistics, Fisher’s exact, Kruskal-Wallis rank sum tests, and generalized estimating equations were performed to identify associations between insurance status and five domains of the BREAST-Q Reconstructive module. Results: 1,285 patients were included, of which 1,011 (78.7%) had commercial, 89 (6.9%) had Medicaid, and 185 (14.4%) had Medicare insurances. Total flap loss rates were significant higher in the Medicare and Medicaid patients as compared to commercial patients; however, commercial patients had a higher rate of wound dehiscence as compared to Medicare patients. With all other factors controlled for, patients with Medicare had lower Physical Well-Being of the Chest (PWBC) than patients with commercial insurance (β =-3.1, 95% CI: -5.0, -1.2, p=0.002). There were no significant associations between insurance classification and other domains of the BREAST-Q. Conclusion: Patients with government issued insurance had lower success rates of autologous breast reconstruction. Further, Patients with Medicare had lower PWBC than patients with commercial insurance regardless of other factors, while other BREAST-Q metrics did not differ. Further investigation as to the causes of such variation is warranted in larger, more diverse cohorts.

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Section: Discussionmentioning

confidence: 61%