A Comparison Of Outcomes And Resource Utilization Between Plastic Surgeons and General Surgeons In Implant Based Breast Reconstruction
Anmol Chattha, BA1, Austin D. Chen2, Ashit Patel, MBChB3.
1Albany Medical College, Albany, NY, USA, 2Kaohsiung Medical University, Kaohsiung, Taiwan, 3Albany Medical Center, Albany, NY, USA.
Despite National Accreditation Program for Breast Centers (NAPBC) standards requiring that all women who will undergo mastectomy are referred to a plastic surgeon, reports indicate that some patients are unable to find plastic surgeons who are willing to participate in their care. This has led to non-plastic surgeons filling this breast reconstruction void. Data on outcomes related to non-plastic surgeons performing breast reconstruction in the United States are limited. We aim to clarify differences in outcomes and resource utilization by surgical specialty for implant based breast reconstruction.
Data was obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2012 to 2014. Patients undergoing immediate implant based reconstruction or immediate/delayed tissue expander based reconstruction were identified (Current Procedural Terminology codes: 19340 and 19357 respectively). Outcomes studied were major and wound-based 30-day complications, operation time, unplanned readmission or reoperation, and length of hospital stay.
We identified 9,264 patients who underwent prosthesis or tissue expander based reconstruction, 8362 (90.3%) by plastic surgeons (PS) and 902 (9.7%) by general surgeons (GS). There were significant differences in BMI (27.49 ± 6.42 PS vs 26.96 ± 6.44 GS; p=0.002) with no other significant differences in patient characteristics. There were significant differences in major complications between specialty (1.2% PS vs 2.8% GS; p<0.001). There were no significant differences in unplanned reoperation (5.3% PS vs 4.9% GS; p= 0.592), unplanned readmissions (4.3% PS vs 3.8% GS; p=0.555), wound dehiscence (0.7% PS vs 0.6% GS; p=0.602) or wound- based infection rates (2.9% PS vs 2.8% GS; p= 0.866). After multivariate regression, patients operated by general surgeons had a greater likelihood of major medical complications (OR, 1.630; 95 percent CI, 1.035 to 2.567; p=0.035). As it pertains to resource utilization, the GS patients had a significantly longer length of stay (1.02 ±4.41 days PS vs 1.62 ±4.07 days GS; p<0.001) and operative time (164.3 ±97.6 minutes PS vs. 185.4 ±126.5 minutes; p=0.001) than PS patients.
This current assessment demonstrates that patients who undergo breast reconstruction by a general surgeon have significantly more major complications and increased resource utilization as assessed by length of stay and operative time. It is beneficial for the health care system for plastic surgeons to be the primary providers of breast reconstruction services. Measures should be taken to ensure that plastic surgeons are available and encouraged to provide this service.
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