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Utilization of Mastectomy and Reconstruction in the Outpatient Setting.
MedLine Citation:
PMID:  22990647     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Reconstruction rates after mastectomy have been reported to range from 25-40 %; however, most studies have focused on patients treated in an inpatient setting. We sought to determine the utilization of outpatient mastectomy and use of breast reconstruction in Southern California. METHODS: Postmastectomy reconstruction rates were determined from the California Office of Statewide Health Planning and Development database from 2006-2009 using CPT codes and similarly from an inpatient database using ICD-9 codes. Reconstruction rates were compared between the inpatient and outpatient setting. For the outpatient setting, univariate and multivariate odds ratios with 95 % confidence intervals were estimated for relative odds of immediate reconstruction versus mastectomy alone. RESULTS: The percentage of patients undergoing outpatient mastectomy ranged from 20.4 to 23.9 % of the total number of all patients undergoing mastectomy. Whereas immediate inpatient reconstruction increased from 29.2 to 41.6 % (overall rate 35.5 %), the proportion of outpatients undergoing reconstruction only increased from 7.7 to 10.3 % (overall rate 9.1 %). Similar to the inpatient setting, in multivariate analysis, age, insurance status, race/ethnicity, and type of hospital were significantly associated with the use of reconstruction in the outpatient setting. CONCLUSIONS: A substantial number of patients undergo outpatient mastectomy with low rates of reconstruction. Although the choice of an outpatient mastectomy may certainly represent a selection bias for those not choosing reconstruction, an increase in the use of outpatient mastectomy may result in decreases in the use of postmastectomy reconstruction.
Authors:
Laura Kruper; Xin Xin Xu; Katherine Henderson; Leslie Bernstein; Steven L Chen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-19
Journal Detail:
Title:  Annals of surgical oncology     Volume:  -     ISSN:  1534-4681     ISO Abbreviation:  Ann. Surg. Oncol.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9420840     Medline TA:  Ann Surg Oncol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA, lkruper@coh.org.
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