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Influence of Multilevel Health Care Factors on Patient Satisfaction with Breast Reconstruction Post-Mastectomy
Rachel E. Schafer, Eduardo Williams, Samantha Maasarani, MD, MPH, Amy S. Nowacki, PhD, Anita Misra-Hebert, MD, MPH, Graham S. Schwarz, MD
Cleveland Clinic
2023-11-27
Presenter: Rachel E. Schafer
Affidavit:
I agree
Director Name: R. Isakov
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
PURPOSE: The emphasis on patient-reported outcomes in breast reconstruction highlights the need for integrating patient satisfaction in assessing procedure success. This study explores healthcare factors at both individual and community levels influencing patient satisfaction post-breast reconstruction.
METHODS: This study included female patients aged 18+ who underwent breast reconstruction post-mastectomy and filled out the postoperative BREAST-Q breast reconstruction questionnaire between January 2019 and December 2020. Demographics, outcomes, and area deprivation index (ADI) were compared to the BREAST-Q satisfaction with outcome domain scores using Kruskal-Wallis rank sum test or linear regression, as appropriate. Patient zip codes may be used to identify the community's ADI, a measure that ranks neighborhoods by socioeconomic disadvantage status.
RESULTS: Of 258 eligible patients, 88% identified as white, 7.4% as Black, and 4.3% as other. Age, BMI, smoking status, history of diabetes or hypertension, breast cancer stage, mastectomy type, reconstruction type, operative time, and intraoperative and postoperative complications, and ADI percentiles were not correlated with satisfaction scores. Radiation history pre-reconstruction was found to have lower median satisfaction scores compared to no radiation or post-reconstruction radiation (pre-reconstruction: 68, no radiation: 76, post-reconstruction: 82, p= 0.003). Black patients were found to have the lowest satisfaction scores compared to the white or other cohorts (Black: 56, white: 76, other: 88, p = 0.027).
CONCLUSIONS: Radiation history and race were found to have a high impact on patient satisfaction with outcome for breast reconstruction post-mastectomy. Factors that influence patient satisfaction should be discussed during surgical evaluation to optimize clinician-patient communication and expectations.
