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Regional Market Competition and the Use of Immediate Breast Reconstruction After Mastectomy.
Wright, Jason D; Chen, Ling; Accordino, Melissa; Taback, Bret; Ananth, Cande V; Neugut, Alfred I; Hershman, Dawn L.
Afiliação
  • Wright JD; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 4th Floor, New York, USA. jw2459@columbia.edu.
  • Chen L; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, USA. jw2459@columbia.edu.
  • Accordino M; New York Presbyterian Hospital, New York, USA. jw2459@columbia.edu.
  • Taback B; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 4th Floor, New York, USA.
  • Ananth CV; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 4th Floor, New York, USA.
  • Neugut AI; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, USA.
  • Hershman DL; New York Presbyterian Hospital, New York, USA.
Ann Surg Oncol ; 26(1): 62-70, 2019 Jan.
Article em En | MEDLINE | ID: mdl-30327971
BACKGROUND: Prior work has shown that the competitiveness of the market in which hospitals operate is associated with use of surgical procedures. This study examined the association between regional market competition and use of breast reconstruction for women with breast cancer and ductal carcinoma in situ undergoing mastectomy. METHODS: Women who underwent mastectomy from 2010 to 2011 recorded in the National Inpatient Sample were selected. The competitive market environment for each hospital in which patients were treated was estimated using the Herfindahl-Hirschman Index. Multivariable models were developed to examine the association between regional market competition and breast reconstruction, with adjustment for other clinical, demographic, and structural variables. RESULTS: Immediate breast reconstruction was performed for 9902 (45%) of 22,011 women. The rate of immediate breast reconstruction was 34.5% at hospitals in non-competitive markets, 49% at hospitals in moderately competitive markets, and 56.4% at hospitals in highly competitive markets (P < 0.0001). In a multivariable model, women in moderately competitive markets were 24% (risk ratio [RR] 1.24; 95% confidence interval [CI] 1.10-1.41) more likely to undergo immediate breast reconstruction than women in noncompetitive markets, whereas those in competitive markets were 25% (RR 1.25; 95% CI 1.11-1.41) more likely to have reconstruction. Later year of treatment, higher census tract income level, and residence in an urban area were associated with an increased likelihood of reconstruction (P < 0.05 for all). In contrast, older age, non-white race, and non-commercial insurance were associated with a lower likelihood of reconstruction (P < 0.05 for all). CONCLUSION: Patients who undergo mastectomy at hospitals in competitive markets are more likely to undergo immediate breast reconstruction.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias da Mama / Marketing de Serviços de Saúde / Mamoplastia / Carcinoma Intraductal não Infiltrante / Atenção à Saúde / Competição Econômica / Mastectomia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Middle aged Idioma: En Revista: Ann Surg Oncol Assunto da revista: NEOPLASIAS Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias da Mama / Marketing de Serviços de Saúde / Mamoplastia / Carcinoma Intraductal não Infiltrante / Atenção à Saúde / Competição Econômica / Mastectomia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Middle aged Idioma: En Revista: Ann Surg Oncol Assunto da revista: NEOPLASIAS Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Estados Unidos