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Local practice variations and payer differences underlie state-wide disparities in oncoplastic breast surgery.
Yang, Alan Z; Hyland, Colby J; Miller, Amitai S; Killelea, Brigid K; Starr, Bryce F; Broyles, Justin M.
Afiliación
  • Yang AZ; Harvard Medical School, Boston, Massachusetts, USA.
  • Hyland CJ; Harvard Medical School, Boston, Massachusetts, USA.
  • Miller AS; Harvard Medical School, Boston, Massachusetts, USA.
  • Killelea BK; Division of Breast Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Starr BF; Harvard Medical School, Boston, Massachusetts, USA.
  • Broyles JM; Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Surg Oncol ; 130(2): 210-221, 2024 Aug.
Article en En | MEDLINE | ID: mdl-38941173
ABSTRACT

BACKGROUND:

Little is known about disparities in oncoplastic breast surgery delivery.

METHODS:

The Massachusetts All-Payer Claims Database was queried for patients who received lumpectomy for a diagnosis of breast cancer. Oncoplastic surgery was defined as adjacent tissue transfer, complex trunk repair, reduction mammoplasty, mastopexy, flap-based reconstruction, prosthesis insertion, or unspecified breast reconstruction after lumpectomy.

RESULTS:

We identified 18 748 patients who underwent lumpectomy between 2016 and 2020. Among those, 3140 patients underwent immediate oncoplastic surgery and 436 patients underwent delayed oncoplastic surgery. Eighty-one percent of patients who underwent oncoplastic surgery did so in the same county as they underwent a lumpectomy. However, the relative frequency of oncoplastic surgery varied significantly among counties. In multivariable regression, public insurance status (odds ratio 0.87, 95% confidence interval 0.80-0.95, p = 0.002) was associated with lower odds of undergoing oncoplastic surgery, even after adjusting for macromastia, other comorbidities, and county of lumpectomy. Average payments for lumpectomy with oncoplastic surgery were more than twice as high from private insurers ($840 vs. $1942, p < 0.001).

CONCLUSION:

Disparities in the receipt of oncoplastic surgery were related to differences in local practice patterns and the type of insurance patients held. Expanding services across counties and considering billing reform may help reduce these disparities.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Mama / Mastectomía Segmentaria / Mamoplastia / Disparidades en Atención de Salud Límite: Adult / Aged / Female / Humans / Middle aged País/Región como asunto: America do norte Idioma: En Revista: J Surg Oncol Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
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XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Mama / Mastectomía Segmentaria / Mamoplastia / Disparidades en Atención de Salud Límite: Adult / Aged / Female / Humans / Middle aged País/Región como asunto: America do norte Idioma: En Revista: J Surg Oncol Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos