PMID- 28953717
OWN - NLM
STAT- MEDLINE
DCOM- 20171012
LR  - 20181002
IS  - 1529-4242 (Electronic)
IS  - 0032-1052 (Linking)
VI  - 140
IP  - 4
DP  - 2017 Oct
TI  - A Retrospective Cohort Study on Payor Type and the Effect on Revisions in Breast 
      Reconstruction.
PG  - 527e-537e
LID - 10.1097/PRS.0000000000003662 [doi]
AB  - BACKGROUND: Patients who are insured by Medicare and Medicaid are less likely to 
      undergo breast reconstruction than their privately insured counterparts. Whether 
      insurance type also affects subsequent revisions remains unknown. This study
      explores the relationship among payor type, revision procedures, and the
      completion of breast reconstruction. METHODS: A retrospective cohort study was
      created including patients who underwent breast reconstruction at the authors'
      institution from 1996 to 2016. Data collected included age, cancer stage, race,
      laterality, initial breast reconstruction type, total number of procedures,
      number of trips to the operating room, and subsequent revisions. Analysis of
      covariance and logistic regression were used to estimate the controlled mean
      number of revisions and probability of completion of reconstruction as a function
      of insurance type. RESULTS: A total of 3113 patients were included: 2271 (72.9
      percent) with private insurance, 450 (14.5 percent) with Medicare, and 392 (12.6 
      percent) with Medicaid. On controlled analysis, there was no difference in total 
      number of procedures, number of revisions, or number of trips to the operating
      room among the three insurance types. There was no difference in the proportion
      of patients undergoing symmetry procedures or nipple-areola reconstruction.
      CONCLUSIONS: To the authors' knowledge, this is the first study to evaluate
      discrepancies in number of procedures, revisions, and the proportion of patients 
      completing breast reconstruction among insurance types. When controlling for
      other factors, the authors report no differences in care based solely on payor
      type. Instead, patient and surgeon variables may be responsible for the
      differences observed, and should be targeted in future research to improve
      equity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
FAU - Odom, Elizabeth B
AU  - Odom EB
AD  - St. Louis, Mo. From the Division of Plastic and Reconstructive Surgery,
      Washington University School of Medicine.
FAU - Sharma, Ketan
AU  - Sharma K
FAU - Grant, David W
AU  - Grant DW
FAU - Buck, Donald W 2nd
AU  - Buck DW 2nd
FAU - Myckatyn, Terence M
AU  - Myckatyn TM
LA  - eng
GR  - T32 CA190194/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Plast Reconstr Surg
JT  - Plastic and reconstructive surgery
JID - 1306050
SB  - AIM
SB  - IM
MH  - Breast Neoplasms/economics/*surgery
MH  - Costs and Cost Analysis
MH  - Female
MH  - Follow-Up Studies
MH  - *Healthcare Disparities
MH  - Humans
MH  - Insurance Coverage/*economics
MH  - Mammaplasty/economics/*methods
MH  - Middle Aged
MH  - Reoperation
MH  - Retrospective Studies
MH  - Time Factors
MH  - United States
PMC - PMC5649631
MID - NIHMS875735
EDAT- 2017/09/28 06:00
MHDA- 2017/10/13 06:00
CRDT- 2017/09/28 06:00
PHST- 2017/09/28 06:00 [entrez]
PHST- 2017/09/28 06:00 [pubmed]
PHST- 2017/10/13 06:00 [medline]
AID - 10.1097/PRS.0000000000003662 [doi]
AID - 00006534-201710000-00007 [pii]
PST - ppublish
SO  - Plast Reconstr Surg. 2017 Oct;140(4):527e-537e. doi:
      10.1097/PRS.0000000000003662.