Impact of Insurance Payer on Type of Breast Reconstruction Performed

Chouairi, Fouad; Mets, Elbert J.; Gabrick, Kyle; Dinis, Jacob; Avraham, Tomer; Alperovich, Michael

doi:10.1097/prs.0000000000006315

Cited by 20 publications

(29 citation statements)

References 30 publications

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“…42 Of note, several studies have found racial and ethnic disparities in surgical access, outcomes, and costs, among other craniofacial surgeries. 2,9,41 One such study by Wu et al 2 found that minority patients had increased surgical costs of CLP repair. Variations in surgical costs are often influenced by differences in length of stay or complication rates.…”

Section: Influential Factors On Cost Of Surgerymentioning

confidence: 99%

Sociodemographic Disparities in Access to Cleft Rhinoplasty

Phillips

Hauc

Sasson

et al. 2022

Journal of Craniofacial Surgery

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Various sociodemographic factors affect patient access to care. This study aims to assess how factors such as government-funded insurance and socioeconomic status impact the ability of adolescents with cleft lip-associated nasal deformities to access secondary rhinoplasty procedures. Patients older than 13 years old with a history of cleft lip/palate were identified in the National Inpatient Sample database from 2010 to 2012. Those who received a secondary rhinoplasty were identified using the International Classification of Diseases, Ninth Revision (ICD-9) procedural codes. A multivariate logistic regression model with post hoc analyses was performed to analyze if insurance status, socioeconomic status, and hospitallevel variables impacted the likelihood of undergoing rhinoplasty. Of the 874 patients with a cleft lip/palate history, 154 (17.6%) underwent a secondary rhinoplasty. After controlling for various patient-level and hospital-level variables, living in a higher income quartile (based on zip code of residence) was an independent predictor of receiving a secondary cleft rhinoplasty (odds ratio = 1.946, P = 0.024). Patients had lower odds of receiving a cleft rhinoplasty if care occurred in a private, nonprofit hospital compared with a government-owned hospital (odds ratio = 0.506, P = 0.030). Income status plays a significant role in cleft rhinoplasty access, with patients from lower income households less likely to receive a secondary cleft rhinoplasty. Hospital-specific factors such as geographic region, bed size, urbanization, and teaching status may also create barriers for patients and their families in accessing surgical care for cleft lip nasal deformities.

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Section: Influential Factors On Cost Of Surgerymentioning

confidence: 99%

Sociodemographic Disparities in Access to Cleft Rhinoplasty

Phillips

Hauc

Sasson

et al. 2022

Journal of Craniofacial Surgery

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“…10–12 Of those patients who do undergo autologous reconstruction, the privately insured have been shown to receive free flap, rather than pedicled, reconstruction at significantly higher rates than those insured by Medicare or Medicaid. 8,10…”

Section: Introductionmentioning

confidence: 99%

“…6,7 It has been proposed that relatively low reimbursement rates from Medicare and Medicaid do not provide sufficient compensation for the increased procedural time and technical skill required for autologous reconstruction, thus disincentivizing utilization of autologous-based reconstruction and possibly accounting for the increasing rates of implant-based reconstruction nationally. 8,9 Previous research has identified a significant disparity in reconstructive modality, based on insurance status, race, and other sociodemographic characteristics. Nonminority, privately-insured women from advantageous socioeconomic backgrounds have been shown to receive autologous-based reconstruction at much higher rates than other breast cancer reconstruction patients.…”

Section: Introductionmentioning

confidence: 99%

The Insurance Landscape for Implant- and Autologous-based Breast Reconstruction in the United States

Boyd

Greenfield

Ainapurapu

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Insurance coverage of postmastectomy breast reconstruction is mandated in America, regardless of reconstructive modality. Despite enhanced patientreported outcomes, autologous reconstruction is utilized less than nonautologous reconstruction nationally. Lower reimbursement from Medicare and Medicaid may disincentivize autologous-based reconstruction. This study examines the impact of insurance and sociodemographic factors on breast reconstruction. Methods: A retrospective analysis of the Healthcare Cost and Utilization Project National Inpatient Sample Database from 2014 to 2017 was performed. International Classification of Diseases Clinical Modification and Procedure Coding System codes were used to identify patients for inclusion. De-identified sociodemographic and insurance data were analyzed using χ 2 , least absolute shrinkage and selection operator regression analysis, and classification trees. Results: In total, 31,468 patients were identified for analysis and stratified by reconstructive modality, sociodemographics, insurance, and hospital characteristics. Most patients underwent nonautologous reconstruction (63.2%). Deep inferior epigastric perforator flaps were the most common autologous modality (46.7%). Least absolute shrinkage and selection operator regression identified Black race, urban-teaching hospitals, nonsmoking status, and obesity to be associated with autologous reconstruction. Publicly-insured patients were less likely to undergo autologous reconstruction than privately-insured patients. Within autologous reconstruction, publicly-insured patients were 1.97 (P < 0.001) times as likely to obtain pedicled flaps than free flaps. Black patients were 33% (P < 0.001) less likely to obtain free flaps than White patients. Conclusions: Breast reconstruction is influenced by insurance, hospital demographics, and sociodemographic factors. Action to mitigate this health disparity should be undertaken so that surgical decision-making is solely dependent upon medical and anatomic factors.

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“…29 In addition, Chouairi et al found that women with private insurance were more likely to undergo autologous reconstruction, but women with Medicaid and Medicare were more likely to undergo prosthetic reconstruction. 30 Although there is a paucity in the literature regarding the association of socioeconomic status and breast reconstruction readmissions, previous work has shown that income inequality is associated with higher readmission rates in heart failure, myocardial infarction, and pneumonia. 31 Readmission following lung lobectomies has also been found to be influenced by median household income and insurance status.…”

Section: Discussionmentioning

confidence: 99%

Autologous Breast Reconstruction is Associated with Lower 90-day Readmission Rates

Sawyer

Franke

Scaife

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Breast reconstruction is associated with improved quality of life after mastectomy. Options for breast reconstruction include autologous and implant-based methods. Although autologous reconstruction is more technically challenging and requires longer operative time, it is thought of as the gold standard. Our study examined differences in 90-day readmission rates between implant-based and autologous breast reconstruction using discharge data from the National Readmission Database, Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality. Methods: The National Readmission Database was used to identify patients undergoing postmastectomy breast reconstruction. Patients were selected using ICD-10 PCS codes linked to autologous and implant-based reconstruction. Ninety-day readmission rates were determined. After matching the two groups on a 1:1 basis for baseline comorbidities and demographics, a multivariable logistic regression analysis was performed to variables associated with higher readmission rates. Results: The leading diagnoses associated with readmissions were infectious and pulmonary. After one to one matching, autologous breast reconstruction, private insurance versus Medicaid, and income quartile 4 versus 1 were all less likely to be readmitted within 90 days of discharge. Patients with a high Charlson index and those with a longer length of initial hospital stay are significantly more likely to be readmitted within 90 days. Conclusions: Patients undergoing autologous breast reconstruction were 23% less likely to be readmitted within 90 days from discharge. Fewer comorbidities, shorter length of hospital stay, and higher socioeconomic status are also associated with lower readmission rates following breast reconstruction.

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Impact of Insurance Payer on Type of Breast Reconstruction Performed

Cited by 20 publications

References 30 publications

Sociodemographic Disparities in Access to Cleft Rhinoplasty

Sociodemographic Disparities in Access to Cleft Rhinoplasty

The Insurance Landscape for Implant- and Autologous-based Breast Reconstruction in the United States

Autologous Breast Reconstruction is Associated with Lower 90-day Readmission Rates

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