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Immediate Breast Reconstruction among Patients with Medicare and Private Insurance: A Matched Cohort Analysis
BACKGROUND: By eliminating economic hurdles, the Women’s Health and Cancer Rights Act of 1998 represented a paradigm shift in the availability of breast reconstruction. Yet, studies report disparities among Medicare-insured women. These studies do not account for the inherent differences in age and...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5811278/ https://www.ncbi.nlm.nih.gov/pubmed/29464148 http://dx.doi.org/10.1097/GOX.0000000000001552 |
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author | Kamali, Parisa Ricci, Joseph A. Curiel, Daniel A. Cohen, Justin B. Chattha, Anmol Rakhorst, Hinne A. Lee, Bernard T Lin, Samuel J. |
author_facet | Kamali, Parisa Ricci, Joseph A. Curiel, Daniel A. Cohen, Justin B. Chattha, Anmol Rakhorst, Hinne A. Lee, Bernard T Lin, Samuel J. |
author_sort | Kamali, Parisa |
collection | PubMed |
description | BACKGROUND: By eliminating economic hurdles, the Women’s Health and Cancer Rights Act of 1998 represented a paradigm shift in the availability of breast reconstruction. Yet, studies report disparities among Medicare-insured women. These studies do not account for the inherent differences in age and comorbidities between a younger privately insured and an older Medicare population. We examined immediate breast reconstruction (IBR) utilization between a matched pre- and post-Medicare population. METHODS: Using the Nationwide Inpatient Sample database (1992–2013), breast cancer patients undergoing IBR were identified. To minimize confounding medical variables, 64-year-old privately insured women were compared with 66-year-old Medicare-insured women. Demographic data, IBR rates, and complication rates were compared. Trend over time was plotted for both cohorts. RESULT: A total of 21,402 64-year-old women and 25,568 66-year-old women were included. Both groups were well matched in terms of demographic type of reconstruction and complication rates. 72.3% of 64-year-old and 71.2 of % 66-year-old women opted for mastectomy. Of these, 25.5% (n = 3,941) of 64-year-old privately insured and 17.7% (n = 3,213) of 66-year-old Medicare-insured women underwent IBR (P < 0.01). During the study period, IBR rates increased significantly in both cohorts in a similar cohort. CONCLUSION: This study demonstrates significant increasing IBR rates in both cohorts. Moreover, after an initial slower upward trend, after a decade, IBR in 66-year-old Medicare-insured women approached similar rates of breast reconstruction among those with private insurance. Trends in unilateral versus bilateral mastectomy are also seen. |
format | Online Article Text |
id | pubmed-5811278 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-58112782018-02-20 Immediate Breast Reconstruction among Patients with Medicare and Private Insurance: A Matched Cohort Analysis Kamali, Parisa Ricci, Joseph A. Curiel, Daniel A. Cohen, Justin B. Chattha, Anmol Rakhorst, Hinne A. Lee, Bernard T Lin, Samuel J. Plast Reconstr Surg Glob Open Original Article BACKGROUND: By eliminating economic hurdles, the Women’s Health and Cancer Rights Act of 1998 represented a paradigm shift in the availability of breast reconstruction. Yet, studies report disparities among Medicare-insured women. These studies do not account for the inherent differences in age and comorbidities between a younger privately insured and an older Medicare population. We examined immediate breast reconstruction (IBR) utilization between a matched pre- and post-Medicare population. METHODS: Using the Nationwide Inpatient Sample database (1992–2013), breast cancer patients undergoing IBR were identified. To minimize confounding medical variables, 64-year-old privately insured women were compared with 66-year-old Medicare-insured women. Demographic data, IBR rates, and complication rates were compared. Trend over time was plotted for both cohorts. RESULT: A total of 21,402 64-year-old women and 25,568 66-year-old women were included. Both groups were well matched in terms of demographic type of reconstruction and complication rates. 72.3% of 64-year-old and 71.2 of % 66-year-old women opted for mastectomy. Of these, 25.5% (n = 3,941) of 64-year-old privately insured and 17.7% (n = 3,213) of 66-year-old Medicare-insured women underwent IBR (P < 0.01). During the study period, IBR rates increased significantly in both cohorts in a similar cohort. CONCLUSION: This study demonstrates significant increasing IBR rates in both cohorts. Moreover, after an initial slower upward trend, after a decade, IBR in 66-year-old Medicare-insured women approached similar rates of breast reconstruction among those with private insurance. Trends in unilateral versus bilateral mastectomy are also seen. Wolters Kluwer Health 2018-01-12 /pmc/articles/PMC5811278/ /pubmed/29464148 http://dx.doi.org/10.1097/GOX.0000000000001552 Text en Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Original Article Kamali, Parisa Ricci, Joseph A. Curiel, Daniel A. Cohen, Justin B. Chattha, Anmol Rakhorst, Hinne A. Lee, Bernard T Lin, Samuel J. Immediate Breast Reconstruction among Patients with Medicare and Private Insurance: A Matched Cohort Analysis |
title | Immediate Breast Reconstruction among Patients with Medicare and Private Insurance: A Matched Cohort Analysis |
title_full | Immediate Breast Reconstruction among Patients with Medicare and Private Insurance: A Matched Cohort Analysis |
title_fullStr | Immediate Breast Reconstruction among Patients with Medicare and Private Insurance: A Matched Cohort Analysis |
title_full_unstemmed | Immediate Breast Reconstruction among Patients with Medicare and Private Insurance: A Matched Cohort Analysis |
title_short | Immediate Breast Reconstruction among Patients with Medicare and Private Insurance: A Matched Cohort Analysis |
title_sort | immediate breast reconstruction among patients with medicare and private insurance: a matched cohort analysis |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5811278/ https://www.ncbi.nlm.nih.gov/pubmed/29464148 http://dx.doi.org/10.1097/GOX.0000000000001552 |
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