UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2008-01-01Keywords
AgedAmbulatory Surgical Procedures
Breast Neoplasms
Female
Humans
Logistic Models
Mammaplasty
Mastectomy
Medicare
SEER Program
United States
Bioinformatics
Biostatistics
Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
BACKGROUND: In the United States, post-mastectomy breast reconstruction is a state (all 51 jurisdictions) and federally mandated benefit. Outpatient mastectomy, which could lower use of breast reconstruction, may raise concerns about whether patients receive adequate post-mastectomy care. METHODS: Using linked surveillance, epidemiology, and end results (SEER)-Medicare data, we identified Medicare fee-for-service women aged 65-69 years, diagnosed with early-stage breast cancer, and receiving unilateral mastectomy from 1998-2002. The corresponding surgery delivery settings were determined from claims data. The outcome of interest was reconstruction within 4 months of diagnosis. We used multivariable logistic regression models to examine the association of outpatient mastectomy with the likelihood of post-mastectomy reconstruction, controlling for patient's characteristics. RESULTS: Among the 3,419 patients in the sample, 717 (21%) patients received outpatient mastectomy. The proportions of patients receiving reconstruction were 13% for inpatient mastectomy patients and 4% for outpatient mastectomy patients. Outpatient mastectomy patients were younger and had less comorbidities than inpatient mastectomy patients. Multivariable regression analysis suggested that outpatient mastectomy patients were less likely to receive reconstruction (odds ratio = 0.247; 95% confidence interval (CI): 0.166-0.368). Additional analysis suggests that African American patients were less likely than white patients to undergo reconstruction (odds ratio = 0.515; 95% CI: 0.293-0.906) and that this ethnic difference was more manifest among patients undergoing inpatient mastectomies. CONCLUSIONS: This study shows that outpatient mastectomy was associated with lower use of breast reconstruction. A better understanding of choice of delivery setting of mastectomy with a focus on younger and minority breast cancer patients should be explored in future research.Source
Ann Surg Oncol. 2008 Apr;15(4):1032-9. Epub 2007 Dec 29. Link to article on publisher's siteDOI
10.1245/s10434-007-9762-4Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47701PubMed ID
18165916Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1245/s10434-007-9762-4