| Abstrakt: |
Background: While insurance coverage for mastectomy-related breast reconstruction is mandated in the US, the impact of insurance type on breast reconstruction outcomes has not been explored. This study aimed to compare short-term outcomes of publicly versus privately insured patients who underwent autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR), respectively. Methods: Patients having ABR or IBR were identified in National Inpatient Sample from Q4 2015–2020. Multivariable logistic regressions were used to compare in-hospital outcomes between publicly (Medicare or Medicaid) versus privately insured patients, adjusted for demographics, socioeconomic status, comorbidities, and hospital characteristics. Results: In ABR, 2,687 patients were publicly insured and 9,770 were privately insured. In IBR, 4,566 patients used public insurance and 12,701 used private insurance. In ABR, publicly insured patients had higher risks of venous thromboembolism (aOR = 1.384, 95 CI = 1.006–1.905, p = 0.04) but were less likely to undergo flap revision (aOR = 0.438, 95 CI = 0.213–0.899, p = 0.02). In IBR, publicly insured patients had higher risks of systemic complications (aOR = 2.084, 95 CI = 1.471–2.951, p < 0.01) including respiratory (aOR = 1.723, 95 CI = 1.06–2.799, p = 0.03) and renal complications (aOR = 2.353, 95 CI = 1.445–3.832, p < 0.01), as well as dehiscence (aOR = 1.282, 95 CI = 1.008–1.631, p = 0.04) and vascular complications (aOR = 3.697, 95 CI = 1.027–13.315, p = 0.04). In both ABR and IBR, publicly insured patients had higher transfer out rates (p < 0.01), longer hospital stays (p < 0.01), but less hospital charge (p < 0.01). Conclusions: Despite extensive legislative efforts to ensure women's access to breast reconstruction services in the US, insurance status still profoundly associated with ABR and IBR outcomes. The probable cause for these disparities is selection bias due to the higher concentration of disadvantaged patients in the publicly insured group. Thus, efforts should focus on improving all quality-of-life metrics for this group. Level of evidence: Level III, Risk/Prognostic. [ABSTRACT FROM AUTHOR] |
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