Plastic Surgery Research Council
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Presenter: Erik M Wolfswinkel, ScB
Co-Authors: Lopez SN; Weathers WM; Qashqai SM; Wang T; Hilsenbeck SG; Rimawi MF; Heller L
Baylor College of Medicine

Objective: Past studies found that a patient s insurance status, race, comorbidities and hospital setting influence the likelihood and timing of reconstruction. We evaluated these factors at a public hospital serving a predominantly minority and uninsured population.

Methods: Women from 2005 to 2011 who underwent mastectomy and/or reconstruction were reviewed. The association between patients characteristics and receipt of reconstruction, timing (immediate vs delayed), and microsurgical techniques were analyzed. The Kaplan-Meier method estimated the 5-year reconstruction rate.

Results: The analysis included 387 patients. The majority were Hispanics (55%), unemployed (44%), and uninsured (40%). 19 patients sought reconstruction following mastectomy at an outside hospital secondary to a change in insurance status or residence. 130 women received reconstruction. 85 (65%) received immediate reconstruction and 25 (19%) underwent microsurgical repair. The total complication rate was 25%. The 5yr reconstruction rate was 43% (95% CI 36%, 51%). Young age, single, non-smoking, lower BMI, lower AJCC stage, and negative lymph nodes are associated with having reconstruction. Young age, higher AJCC stage, and positive lymph nodes are negatively associated with immediate reconstruction. Race and insurance type were not significantly associated with reconstruction or timing. Multivariate regression models show younger age (p=0.0002), BMI<30 (p=0.0012), and negative lymph nodes (p=0.0099) are more likely to have reconstruction: younger age (p=0.0004) are more likely to have delayed reconstruction. Immediate reconstruction was associated with the year of mastectomy (p=0.0308) and increased during later years.

Conclusion: At a large public hospital serving a largely uninsured population, rates of immediate and 5-year reconstruction are 22% and 43.1%, respectively. Immediate reconstruction increased in later years. The complication rate was low and microsurgical techniques were used in a substantial fraction. These results show that insurance status and race need not be the largest predictors of reconstruction and quality of care.

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