Understanding Disparities in Post-mastectomy Breast Reconstruction Utilization in the Rural State of Nevada
Plastic and Reconstructive Surgery - Global Open
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Purpose: Despite federally mandated insurance coverage and clear benefits of breast reconstruction after mastectomy, reported rates remain low at 23-63%. We hypothesize that rates and types of reconstruction would be disproportionately lower in the rural state of Nevada. The goal of this study was to identify and understand disparities in breast reconstruction utilization in Nevada compared to the nation. Methods: Breast cancer patient information (2008-2013) was aggregated from AHRQ’s HCUP Nationwide Inpatient Sample (NIS) and the Nevada State Inpatient Database (NV SID). Chi-square analysis for two population proportions was used to determine differences between the NV SID (n=7,466) and NIS (n=1,231,428) mastectomy and breast reconstruction cases with statistical significance considered p<.05. Autologous reconstruction was further separated into pedicled and free tissue transfer for analysis. Results: The percentage of mastectomies performed in Nevada per patient with breast cancer was compared to nationwide values. Nevada was significantly lower in overall reconstruction at only 38.8% compared to 47.2% nationwide (p<.001). Subgroup analysis of autologous reconstructions demonstrates that free tissue transfer accounts for 51.3% of cases performed nationally compared to only 9.3% of cases performed in Nevada. Conclusion: Utilization of breast reconstruction in Nevada is significantly lower compared to the rest of the nation. Perhaps more striking is the fact that less than 10% are autologous free flap reconstructions despite increasing national trends. The results of this study will be essential in highlighting the disparities in rural states such as Nevada and developing programs to improve outreach and delivery of optimal post-cancer breast reconstruction.
Mastectomy; Breast reconstruction; Nevada; Breast cancer
Medical Specialties | Medicine and Health Sciences | Plastic Surgery
Vest, M. O.,
Baynosa, R. C.,
Williams, S. J.,
Cross, C. L.,
Understanding Disparities in Post-mastectomy Breast Reconstruction Utilization in the Rural State of Nevada.
Plastic and Reconstructive Surgery - Global Open, 8(7S),