Impact of Insurance Status on Postoperative Recovery after Microsurgical Breast Reconstruction

Area of Science:

• Plastic Surgery
• Health Services Research
• Health Equity

Background:

• Persistent disparities in breast reconstruction access are well-documented.
• A gap exists in understanding the impact of social determinants of health (SDOH) on postoperative outcomes.
• This study investigates SDOH's influence on breast reconstruction recovery.

Purpose of the Study:

• To analyze the impact of insurance status as a proxy for SDOH on outcomes.
• To compare postoperative recovery milestones and complications between publicly and privately insured patients.
• To identify factors associated with extended length of stay (LOS) after breast reconstruction.

Main Methods:

• Retrospective chart review of 162 patients undergoing abdominal-based free-flap breast reconstruction.
• Stratification of patients by public (Medicare/Medicaid) versus private insurance.
• Comparison of demographics, LOS, recovery milestones, and complications.

Main Results:

• Publicly insured patients were more likely to be Hispanic and Spanish-speaking.
• Publicly insured patients experienced a significantly longer LOS (3.6 vs. 3.0 days).
• Public insurance status was independently associated with extended LOS, longer recovery, and higher complication rates.

Conclusions:

• Public insurance status, as a proxy for SDOH disadvantage, predicts extended LOS and recovery delays.
• Microsurgical breast reconstruction outcomes are influenced by socioeconomic factors.
• Quality improvement initiatives are needed to mitigate disparities in breast reconstruction care.