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J Reconstr Microsurg
DOI: 10.1055/a-2277-0236
Original Article

Social Determinants of Health and Patient-reported Outcomes Following Autologous Breast Reconstruction, Using Insurance as a Proxy

Ethan L. Plotsker   *
1   Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Francis D. Graziano   *
1   Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Minji Kim
1   Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Lillian A. Boe
2   Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
,
Audree B. Tadros
3   Breast Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Evan Matros
1   Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Said C. Azoury
4   Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
,
Jonas A. Nelson
1   Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
› Author Affiliations Funding This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748, which supports Memorial Sloan Kettering Cancer Center's research infrastructure.
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Abstract

Background Insurance type can serve as a surrogate marker for social determinants of health and can influence many aspects of the breast reconstruction experience. We aimed to examine the impact of insurance coverage on patients reported outcomes with the BREAST-Q (patient reported outcome measure for breast reconstruction patients, in patients receiving) in patients receiving deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.

Methods We retrospectively examined patients who received DIEP flaps at our institution from 2010 to 2019. Patients were divided into categories by insurance: commercial, Medicaid, or Medicare. Demographic factors, surgical factors, and complication data were recorded. Descriptive statistics, Fisher's exact, Kruskal–Wallis rank sum tests, and generalized estimating equations were performed to identify associations between insurance status and five domains of the BREAST-Q Reconstructive module.

Results A total of 1,285 patients were included, of which 1,011 (78.7%) had commercial, 89 (6.9%) had Medicaid, and 185 (14.4%) had Medicare insurances. Total flap loss rates were significantly higher in the Medicare and Medicaid patients as compared to commercial patients; however, commercial patients had a higher rate of wound dehiscence as compared to Medicare patients. With all other factors controlled for, patients with Medicare had lower Physical Well-being of the Chest (PWBC) than patients with commercial insurance (β = − 3.1, 95% confidence interval (CI): −5.0, −1.2, p = 0.002). There were no significant associations between insurance classification and other domains of the BREAST-Q.

Conclusion Patients with government-issued insurance had lower success rates of autologous breast reconstruction. Further, patients with Medicare had lower PWBC than patients with commercial insurance regardless of other factors, while other BREAST-Q metrics did not differ. Further investigation as to the causes of such variation is warranted in larger, more diverse cohorts.

Keywords

social determinants of health - insurance - disparities - breast - autologous - DIEP

* These authors contributed equally to this manuscript and should be viewed as cofirst authors.




Publication History

Received: 25 January 2024

Accepted: 26 February 2024

Accepted Manuscript online:
27 February 2024

Article published online:
12 April 2024

© 2024. Thieme. All rights reserved.

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