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National Disparities in Postmastectomy Breast Reconstruction: A Comparative Demographics and Cost Analysis
Yida Cai BA, Lesley Summerville BS, ScM, Samuel Boas BS, Arvin Smith BS, Anand Kumar MD
Case Western Reserve University School of Medicine
2020-01-31
Presenter: Yida Cai
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The submitted abstract represents the original work of medical students and residents
Director Name: Anand Kumar MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose: There is significant cost variation across all forms of post-mastectomy breast reconstruction. Our study compares trends in hospital charges relating to free flap breast reconstruction when compared to the implant based alternative.
Methods: The National Inpatient Sample was analyzed from January 2009 to December 2014. All patients diagnosed with breast cancer or at a high risk for breast cancer who underwent mastectomy with either autologous free flap or implant based breast reconstruction were included. Univariate and generalized linear models were used compare differences in cost and demographics between the procedures.
Results: 659,220 female patients were diagnosed with breast cancer or had a high risk of breast cancer in the study. 44,175 (6.7%) received implant and 20,050 (3.0%) received free flap. Patients who received free flap were younger (50.31 vs 50.79, p = 0.01). More minorities received free flap (p < 0.001). Higher volumes of free flap were associated with larger, teaching hospitals in the south (p < 0.001). The volume of implant procedures remained stable (p = 0.113), while free flap increased (p = 0.02). Implant were associated with less charges than free flap (mean = $98,468.15 vs $64,632.54, p < 0.001), however both procedures were associated with increasing charges.
Conclusion: Autologous free flap reconstruction is growing in popularity. Increases in hospital charges were found to be associated with both procedures, despite significant differences in demographics and hospital characteristics. Further studies will be done to better identify factors influencing access and cost to different types of breast reconstruction.
