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Accessibility of neurotization in deep inferior epigastric perforator flap reconstruction: a single center analysis
Rachel E. Schafer, Shannon S. Wu, Priya Shukla, Steven Bernard MD, Graham Schwarz MD, Sarah N. Bishop MD, Raffi Gurunian MD, Risal Djohan MD
Department of Plastic Surgery, Cleveland Clinic
2023-01-14
Presenter: Rachel E Schafer
Affidavit:
I agree with the breakdown of work listed below for Rachel Schafer.
Director Name: Steven Bernard
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose: Breast anesthesia after mastectomy is a common side effect of surgery that negatively impacts quality of life. Neurotization during deep inferior epigastric perforator (DIEP) breast reconstruction offers enhanced sensory recovery. However, access to neurotization for DIEP reconstruction patients has not been evaluated.
Methods: This retrospective study included patients who underwent DIEP breast reconstruction between January 2021 and July 2022 at a tertiary-care, academic institution. Sample size was limited due to COVID-19. Demographics and outcomes were compared using two-sample t-test or Chi-square analysis.
Results: Of the 145 patients who met criteria, 43% had neurotization of their DIEP flaps. Overall, median age was 51 years old (IQR: 44, 57) and median BMI was 28.8 (IQR: 25.1, 32.3). Patients who had neurotization did not differ by history of tobacco use (28.6% vs 35.4%), diabetes (14.3% vs 8.5%), operative time (9.43 hr vs 9.75 hr), length of hospital stay (9.43 d vs 9.75 d), hospital readmission (7.9% vs 7.3%), or reoperation (11.1% vs 12.2%) compared to patients without neurotization. However, access to neurotization differed significantly by patient health insurance type. The most common insurance types were MMO and Anthem where 7.4% (2/27) and 53.8% (14/26) of patients received neurotization, respectively (p<0.001).
Conclusions: Access to neurotization differed significantly by patient health insurance. Expanding insurance coverage to cover neurotization is needed to increase equitable access and enhance quality of life.
