Breast Reconstruction: Do Outcomes Differ Between Academic and Community Practices?
Kyle Gabrick, MD1, Fouad Chouiari, BS1, Michael Alperovich, MD1, Elbert J. Mets, BS1, Jacob Dinis, BS2, Tomer Avraham, MD1.
1Yale University, New Haven, CT, 2Quinnipiac University Frank H Netter School of Medicine, North Haven, CT.
Purpose: Breast reconstructions are performed in both community and academic surgical practices. The chief aim of this project is to determine the differences in medical comorbidities, reconstructive modalities, payer status, and surgical outcomes between practice settings. Methods:
All patients undergoing breast reconstruction from 2013-2018 were included. Collected data included reconstructive modality, medical comorbidities, payer status, and complication profiles. Results were further subdivided to evaluate academic versus community plastic surgeons. Results: One thousand and forty-five patients (1,683 breasts) underwent breast reconstruction during the study period. Fifty two point eight percent were performed by surgeons in academic practice while (47.2%) were performed by surgeons in a community-based practice. Patients in the academic setting had a 5.5% greater prevalence of any psychiatric diagnosis (p=0.004), and 7.1% more frequent history of prior open abdominal surgery (p<0.001) and 2.6% increased prevalence of diabetes (p=0.064). Outcomes were similar between the groups except for higher infection rates (p=0.027) and implant removal rates (p=0.003) in the community cohort. When evaluating insurance status, the academic plastic surgery cohort had 30.5% fewer patients with commercial insurance, 16.7% more patients with Medicaid, and 6.1% more patients with Medicare (p<0.001). Conclusions: Within our institution, academic and community-based plastic surgeons perform breast reconstruction with similar complication profiles. Patients treated by academic surgeons have a higher rate of pre-operative medical and psychiatric comorbidities as well as higher percentages of Medicaid and Medicare. Patients treated by community surgeons have higher rates of infection and implant explant in addition to higher proportions of commercial insurance.
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