Utilization of Mastectomy and Reconstruction in the Outpatient Setting

Abstract

Background Reconstruction rates after mastectomy have been reported to range from 25–40 %; however, most studies have focused on patients treated in an inpatient setting. We sought to determine the utilization of outpatient mastectomy and use of breast reconstruction in Southern California. Methods Postmastectomy reconstruction rates were determined from the California Office of Statewide Health Planning and Development database from 2006–2009 using CPT codes and similarly from an inpatient database using ICD-9 codes. Reconstruction rates were compared between the inpatient and outpatient setting. For the outpatient setting, univariate and multivariate odds ratios with 95 % confidence intervals were estimated for relative odds of immediate reconstruction versus mastectomy alone. Results The percentage of patients undergoing outpatient mastectomy ranged from 20.4 to 23.9 % of the total number of all patients undergoing mastectomy. Whereas immediate inpatient reconstruction increased from 29.2 to 41.6 % (overall rate 35.5 %), the proportion of outpatients undergoing reconstruction only increased from 7.7 to 10.3 % (overall rate 9.1 %). Similar to the inpatient setting, in multivariate analysis, age, insurance status, race/ethnicity, and type of hospital were significantly associated with the use of reconstruction in the outpatient setting. Conclusions A substantial number of patients undergo outpatient mastectomy with low rates of reconstruction. Although the choice of an outpatient mastectomy may certainly represent a selection bias for those not choosing reconstruction, an increase in the use of outpatient mastectomy may result in decreases in the use of post-mastectomy reconstruction.

Trends in immediate breast reconstruction across insurance groups after enactment of breast cancer legislation

“…It is possible that the patterns of undergoing immediate breast reconstruction based on payer type may differ in the outpatient setting and, thus, may influence our findings if we were to consider all mastectomies. A recent study reported that >20% of mastectomies are performed in the outpatient setting, and the overwhelming majority of those patients do not undergo reconstruction . Thus, our study may overestimate the overall rates of immediate breast reconstruction in the United States.…”

Variation in Contralateral Prophylactic Mastectomy Rates According to Racial Groups in Young Women with Breast Cancer, 1998 to 2011: A Report from the National Cancer Data Base

“…A CPM has not been shown to provide a definitive survival benefit 4,6,37,38 for all patients and has been associated with increased surgical complications. 17,39,40 Patients also choose CPM to decrease their risk of contralateral breast cancer, but rates of contralateral breast cancer are low.…”

Emerging trends in surgical and adjuvant radiation therapies among women diagnosed with ductal carcinoma in situ

“…The decision to undergo mastectomy may be influenced by multifocal or widespread disease, positive margins, age, physician's preference, access to radiation facilities, fear of recurrence, and insurance coverage. 19,20,42 For many women, bilateral mastectomy may be considered aggressive treatment because of the generally low absolute risk of a future invasive carcinoma. There is no overall survival benefit for contralateral risk-reducing mastectomy in early-stage breast cancer among estrogen receptor-negative patients.…”