Impact of Availability of Immediate Breast Reconstruction on Bilateral Mastectomy Rates for Breast Cancer across the United States: Data from the Nationwide Inpatient Sample
Impact of Availability of Immediate Breast Reconstruction on Bilateral Mastectomy Rates for Breast Cancer across the United States: Data from the Nationwide Inpatient Sample
复制标题
DOI：
10.1245/s10434-014-3924-y
复制
发表时间：
2014-10-01
影响因子：
3.7
通讯作者：
Boughey, Judy C.
中科院分区：
文献类型：
--
作者：
Habermann, Elizabeth B.;Thomsen, Kristine M.;Boughey, Judy C.
背景即时乳房再造（IBR）的可用性因机构而异，但IBR可用性对乳腺癌双侧乳房切除术（BM）与单侧乳房切除术（UM）的影响尚不清楚。从2002年到2010年的全国住院患者样本中，我们使用ICD-9编码确定了接受UM或BM伴或不伴IBR的乳腺癌女性。如果至少有一次住院治疗包括乳房切除术和再造术，则将医院分类为进行IBR，然后按IBR量分类。统计学比较采用卡方检验、趋势检验和多变量logistic回归。我们确定了130，420名接受UM（76.9%）或BM（23.1%）治疗乳腺癌的女性。在6，579家医院中，3，358家（51.0%）没有进行IBR，而在其余的3，221家医院中，每年进行1至638次IBR。大型，教学，城市和东北部医院更有可能有较高的IBR量。在IBR量较高的医院治疗的患者中，BM率显著较高，从每年进行≥ 24次IBR的医院的33.1%到没有IBR的医院的9.0%（p < 0.001）。经校正分析，选择BM的患者更有可能在每年进行≥ 24次IBR的医院就诊（比值比1.69 vs. UM，p < 0.001）。在对国家数据的分析中，在IBR可用的医院中，BM率较高，这表明制度因素对乳腺癌患者的治疗选择有显著影响。需要努力确保患者在需要时能够获得IBR，并更好地了解医院BM率变化的原因。
Background. Availability of immediate breast reconstruction (IBR) varies among institutions, yet the impact of IBR availability on the rates of bilateral mastectomy (BM) versus unilateral mastectomy (UM) for breast cancer is unknown.Methods. From the 2002 to 2010 Nationwide Inpatient Sample, we identified women with breast cancer undergoing UM or BM with and without IBR using ICD-9 codes. Hospitals were classified as performing IBR if at least one hospitalization included both mastectomy and reconstruction and then by IBR volume. Statistical comparisons utilized Chi square tests, tests for trend, and multivariable logistic regression.Results. We identified 130,420 women undergoing UM (76.9 %) or BM (23.1 %) for breast cancer. Of 6,579 hospitals, 3,358 (51.0 %) performed no IBRs, while in the remaining 3,221 hospitals, 1 to 638 IBRs were performed per year. Large, teaching, urban, and Northeastern hospitals were more likely to have higher IBR volumes. BM rates were significantly higher in patients treated at those hospitals with higher IBR volumes, from 33.1 % at hospitals performing >= 24 IBRs per year to 9.0 % at hospitals without IBR (p < 0.001). Upon adjusted analysis, patients who elected BM were more likely to be seen at hospitals performing >= 24 IBRs per year (odds ratio 1.69 vs. UM, p < 0.001).Conclusions. In this analysis of national data, BM rates were higher in hospitals where IBR was available, suggesting a significant influence of institutional factors on treatment options for breast cancer patients. Efforts are needed to ensure patients have access to IBR when desired and to better understand the reasons for hospital variation in BM rates.