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"Implant-Based Breast Reconstruction Outcomes and Access in Patients With Housing Instability: A Retrospective Cohort
Natalie M Guzman1,2,3, Sharmi C Amin2, Brigit D Baglien4
1Department of Learning Health Sciences, Ann Arbor, MI.
Background:
Housing instability significantly impacts surgical outcomes, with studies showing increased complications and mortality. However, research has primarily focused on emergent and urgent procedures rather than elective surgeries like breast reconstruction. A better understanding of the relationship between housing instability and surgical outcomes in the elective setting can inform strategies to provide more comprehensive, holistic care. Therefore, we sought to determine whether implant-based breast reconstruction can be safely performed in patients with housing instability.
Methods:
We conducted a retrospective cohort study using the PearlDiver Mariner claims database (2017-2023) of adult females undergoing implant-based breast reconstruction. Our exposure was housing instability, defined by ICD-10 Social Determinants of Health Z-Codes. Our primary outcome was 90-day surgical complications. Secondary outcomes included medical complications, readmissions, length of stay, and reconstructive failure.
Results:
562 (0.6%) patients had coded housing instability. Patients with housing instability demonstrated higher rates of chronic medical conditions, anxiety, depression, and recent tobacco use. Housing instability was associated with increased rates of 90-day surgical complications (18.1% vs 10.7%; P<.001), 90-day medical complications (11.2% vs 4.4%; P<.001), 30-day readmission rates (5.5% vs 2.6%; P<.001), and one-year reconstructive failure rates (9.8% vs 6.2%; P<.001). After adjusting for mental health, tobacco use, and comorbidities, there was no significant difference in surgical complications, readmission rates, or reconstructive failure compared to patients without housing instability.
Conclusions:
Comorbidity burden and modifiable health behaviors appear to be primary drivers of increased complications among patients with housing instability; however, appropriate preoperative optimization may enable safe breast reconstruction without elevated risk.
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