Improved Rates of Immediate Breast Reconstruction at Safety Net Hospitals

Area of Science:

• Oncology
• Health Services Research
• Surgical Outcomes

Background:

• Federal funding aims to ensure high-quality care at safety net hospitals.
• Patient-level disparities in breast reconstruction exist, but hospital factors are less understood.
• Investigating immediate breast reconstruction rates in safety net versus non-safety net hospitals.

Purpose of the Study:

• To compare the rates of immediate post-mastectomy breast reconstruction between safety net and non-safety net hospitals.
• To identify factors influencing disparities in breast reconstruction.
• To assess trends in reconstruction rates over time.

Main Methods:

• Analysis of the Nationwide Inpatient Sample database for women aged 21+ undergoing mastectomy with immediate reconstruction.
• Definition of safety net hospitals based on Medicaid disproportionate share payment adjustments.
• Logistic regression to calculate adjusted odds ratios for reconstruction.

Main Results:

• Immediate reconstruction rates were 31% at safety net hospitals vs. 46% at non-safety net hospitals (p < 0.001).
• Women at non-safety net hospitals had higher odds of undergoing reconstruction (OR, 1.89; 95% CI, 1.65-2.16).
• Reconstruction rates at safety net hospitals showed an increasing trend over the study period.

Conclusions:

• Women at safety net hospitals remain less likely to receive immediate breast reconstruction, even after adjusting for sociodemographic factors.
• The disparity in reconstruction rates between hospital types has decreased over time.
• Enhancing access to immediate breast reconstruction is vital for mitigating psychological distress post-mastectomy.