Disparities in Reconstruction Rates After Mastectomy: Patterns of Care and Factors Associated with the Use of Breast Reconstruction in Southern California
Disparities in Reconstruction Rates After Mastectomy: Patterns of Care and Factors Associated with the Use of Breast Reconstruction in Southern California
复制标题
DOI：
10.1245/s10434-011-1580-z
复制
发表时间：
2011-08-01
影响因子：
3.7
通讯作者：
Ellenhorn, Joshua
中科院分区：
文献类型：
--
作者：
Kruper, Laura;Holt, Alicia;Ellenhorn, Joshua
许多因素影响乳腺癌患者是否接受乳房切除术后重建。我们试图确定南加州乳房再造的护理模式和变量，从2003年至2007年的加州全州健康计划和发展办公室（OSHPD）住院患者数据库中确定乳房切除术后再造率。国际疾病分类-9代码用于识别乳房切除术后接受重建的患者。重建率的变化通过日历年、年龄、种族、保险类型和医院类型进行卡方检验。单变量和多变量比值比（OR）和95%置信区间（95%CI）估计的相对优势，立即重建与乳房切除only.在多变量分析中，日历年，年龄，种族，保险类型，医院类型与使用重建统计学显着相关。接受重建的患者比例从2003年的24.8%上升到2007年的29.2%。有私人保险的患者接受重建的可能性是Medi-Cal保险患者的10倍（OR 9.95，95% CI 8.46-11.70）。非裔美国人患者（OR 0.58，95% CI 0.46-0.73），亚洲患者的可能性为三分之一（OR 0.37，95%CI 0.29-0.47）与白人患者一样接受乳房再造大多数乳房再造手术是在教学医院和指定的癌症中心进行的，虽然乳房切除术后乳房再造的比率在增加，只有少数患者接受了重建。年龄、种族、保险类型和医院类型似乎是限制使用重建的重要因素。
Many factors influence whether breast cancer patients undergo reconstruction after mastectomy. We sought to determine the patterns of care and variables associated with the use of breast reconstruction in Southern California.Postmastectomy reconstruction rates were determined from the California Office of Statewide Health Planning and Development (OSHPD) inpatient database from 2003 to 2007. International Classification of Disease-9 codes were used to identify patients undergoing reconstruction after mastectomy. Changes in reconstruction rates were examined by calendar year, age, race, type of insurance, and type of hospital using a chi-square test. Univariate and multivariate odds ratios (OR) with 95% confidence intervals (95% CI) were estimated for relative odds of immediate reconstruction versus mastectomy only.In multivariate analysis, calendar year, age, race, type of insurance, and type of hospital were statistically significantly associated with use of reconstruction. The proportion of patients undergoing reconstruction rose from 24.8% in 2003 to 29.2% in 2007. Patients with private insurance were 10 times more likely to undergo reconstruction than patients with Medi-Cal insurance (OR 9.95, 95% CI 8.46-11.70). African American patients were less likely (OR 0.58, 95% CI 0.46-0.73) and Asian patients one-third as likely (OR 0.37, 95% CI 0.29-0.47) to undergo reconstruction as Caucasians patients Most reconstructive procedures were performed at teaching hospitals and designated cancer centers.Although the rate of postmastectomy reconstruction is increasing, only a minority of patients undergo reconstruction. Age, race, type of insurance, and type of hospital appear to be significant factors limiting the use of reconstruction.