Influence of hospital characteristics on immediate breast reconstruction following mastectomy.

Abstract

6118 Background: Immediate breast reconstruction (IBR) following mastectomy is underutilized in the U.S. Racial, economic and geographic factors are associated with lower rates of IBR. Prior research has explored the association of individual and surgeon-level factors with the use of IBR, with little attention paid to hospital characteristics. Methods: We analyzed data from the 2008 Nationwide Inpatient Sample (NIS), a 20% random sample of academic, public and private U.S. hospitals. We used ICD-9 codes to identify women diagnosed with invasive breast cancer or DCIS who underwent mastectomy, and IBR (natural or expander/implant). If a hospital performed at least one IBR during 2008, they were classified as performing reconstruction. Relative risk regression was used to assess the hospital factors associated with a hospital performing IBR. Results: Of the 3,518 hospitals that performed mastectomy in 2008 only 50.4% performed at least one IBR. For hospitals that did not perform IBR, the average number of mastectomies was 5, compared to 35 at hospitals that did perform IBR (p<0.01). Among hospitals that did perform IBR, the mean proportion of mastectomy patients that had IBR was 34% (SD=20). In a multivariable adjusted model, urban/teaching (RR=3.47) and urban/non-teaching (RR=2.86) hospitals were significantly more likely to perform IBR compared to rural hospitals. Hospitals with a high proportion of privately insured patients (RR=1.10) were significantly more likely to perform IBR compared to hospitals with a low proportion of privately insured patients. In contrast, hospitals with a high proportion of publically insured patients (RR=0.24) and hospitals with a high proportion of female patients ≥ 70 years old (RR=0.75) were significantly less likely to perform IBR. Hospital region, hospital ownership status and the proportion of nonwhite patients were not significantly associated with IBR. Conclusions: Almost half of all U.S. hospitals where mastectomies are performed do not have any patients who have undergone IBR. The likelihood a hospital will perform IBR varies significantly by hospital characteristics.