<< Back to the abstract archive
Preoperative SN-N and N-IMF Can Predict Reduction Mammaplasty Insurance Coverage
Xiao Zhu
Jennifer Hall
Michael Gimbel
Vu Nguyen
University of Pittsburgh Medical Center
2020-01-11
Presenter: Xiao Zhu
Affidavit:
The entirety of the project represents the original work of the resident.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Dr. Schnur published a landmark paper in 1991, which was the first to evaluate indications for reduction mammaplasty. The majority of insurance providers still utilize this Schnur 22nd percentile resection minimum for insurance approval or denial. Although multiple studies have sought to better predict resection weights, none have looked to predict insurance coverage based on commonly used resection minimums mandated by third party payers.
Methods: Single center retrospective review of bilateral reduction mammaplasty patients from one surgeon from 2007-2018. 152 patients included in this study. Multiple linear regression, exponential modeling, and published Appel and Deschamps equations were used to predict resection weights based off commonly obtained pre-op measurements. These predicted weights were compared to the Schnur 22nd percentile cutoff and 500g minimum resection weights.
Results: The surgeon had a 70% accuracy in obtaining resection weights above both the Schnur and 500g minimums. Exponential modeling based off of SN-N + N-IMF measurements (R2=0.70) performed the best in predicting Schnur and 500g resection minimums, with accuracies of 85% and 89%, respectively. Multiple linear regression (R2=0.76) had respective accuracies of 79% and 88%, Appel (R2=0.70) had respective accuracies of 80% and 88%, while Deschamps (R2=0.64) had respective accuracies of 77% and 82%.
Conclusions: While surgeon accuracy of 70% in obtaining resection minimums performs well, it leaves the remaining 30% at risk for insurance coverage denial. Utilizing a simple exponential equation based off SN-N and N-IMF, accuracies of at least 85% can be obtained.
