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Disparity in Rate of Immediate Breast Reconstruction at Safety Net Hospitals
Tiffany N.S. Ballard, MD, Lin Zhong, MPH, Adeyiza O. Momoh, MD, Kevin C. Chung, MD, MS, Jennifer F. Waljee, MD, MPH, MS.
University of Michigan, Ann Arbor, MI, USA.

PURPOSE: Considerable federal resources are directed to ensure that safety net hospitals (SNHs) provide equivalent care to vulnerable patients, and previous studies have demonstrated their efficacy. In this context, we sought to determine if rates of immediate breast reconstruction were similar between SNHs and non-safety net hospitals (nSNHs).
METHODS: Women ages 21-64 with breast cancer or increased risk of breast cancer undergoing mastectomy and immediate reconstruction were identified in the National Inpatient Sample database. SNHs were defined as hospitals with the highest quartile of disproportionate share hospital percentage. Adjusted odds ratios of undergoing autologous or implant-based reconstruction were calculated using multinomial logistic regression.
RESULTS: Between 2005 and 2011, 67,478 mastectomies were performed. There were 9,922 autologous reconstructions, with 16% (n=7,833) at nSNHs compared to 12% (n=2,089) at SNHs (p=<0.001). Logistic regression controlling for age, race, primary payer, and chronic conditions revealed that patients at SNHs remained significantly less likely to undergo either autologous (OR 0.79, CI 0.74-0.84) or implant-based reconstruction (OR 0.82, CI 0.78-0.86) compared to those at nSNHs.

CONCLUSION: Even after accounting for sociodemographic factors, women treated at SNHs are less likely to receive breast reconstruction. Given the strong evidence supporting the long-term psychosocial benefits of reconstruction, it is critical to understand why reconstruction rates continue to lag at SNHs, despite federal efforts to ensure high quality care for vulnerable individuals.


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