S6-3: Influence of Hospital Factors, Physician Factors and Type of Health Insurance on Receipt of Immediate Postmastectomy Reconstruction in Young Women with Breast Cancer.

Abstract

Abstract Objective For women with breast cancer who choose mastectomy, breast reconstruction is known to offer a cosmetic and psychological advantage. Despite this, only a minority of patients undergo post mastectomy reconstruction. Little is known about factors that influence reconstruction in younger women who undergo mastectomy. We evaluated the association of demographic, hospital, physician and insurance factors with receipt of immediate breast reconstruction. Methods We used the Perspective database to identify women who underwent a mastectomy for breast cancer from 2000–2010. Perspective is a voluntary, fee-supported database that samples more than 500 acute-care hospitals throughout the United States that contribute data on inpatient hospital admissions. ICD-9 procedure codes were used to identify women who underwent reconstruction at the time of mastectomy. Differences in reconstruction rates over time were examined by age, race, and type of insurance (commercial, Medicaid, Medicare and self-pay). Logistic regression analysis was used to determine factors predictive of immediate breast reconstruction after mastectomy. Additional analyses were done on the population of younger women (<50 years of age). Results We identified 106,988 women with breast cancer who underwent mastectomy, and of these, 24,150 (22.6%) underwent immediate reconstruction. From 2000 to 2010,, reconstruction rates increased from 15% to 33.3%, increasing the most for women with commercial insurance (25.3% to 54.6%) and women under the age of 50 (29% to 60%); for women under the age of 50 with commercial insurance the rate in 2010 was 67.5%. Multivariable analysis found that reconstruction was significantly less likely with increasing age, black race (OR=0.66), rural hospital location (OR=0.48), non-teaching hospital (OR=0.82) and >2 co-morbid conditions (OR=0.72). Odds of reconstruction increased with commercial (OR=3.0) and public (OR=1.6) insurance (compared to self-pay), bilateral mastectomies (OR=2.5), being single (OR=1.09) and increased hospital volume (OR=1.94). No association was found with breast surgeon volume. Similar associations were seen in the subgroup of women <50 years of age. Prolonged length of stay was greater for women undergoing reconstruction (29.2% vs. 18.5%, p<0.0001); however, in-hospital complication rates were similar at 5.6% and 5.3%, respectively. Conclusion Despite its benefits, less than one-third of all women, and half of women under the age of 50, received post mastectomy reconstruction in 2010. Insurance status was one of the largest predictors of immediate reconstruction, and its influence has increased over time. Public policy should ensure that access to reconstructive surgery is available to all women, regardless of insurance type. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr S6-3.