Outcomes in Academic and Community Based Plastic Surgery Practices
Kyle Gabrick, MD, Michael Alperovich, M.D., M.Sc., Fouad Chouiari, BS, Elbert Mets, BA, Jacob Dinis, BS, Tomer Avraham, MD, DMD.
Yale University, New Haven, CT, USA.
BACKGROUND: Breast reconstructions may be performed in both community and academic surgical practices. Yale New Haven hospital is unique in that both academic and community-based plastic surgeons perform breast reconstructions at the same hospital. The aim of this study is to compare practice patterns in breast reconstruction between the two practice settings within a single institution. METHODS: This is a retrospective review of patients undergoing breast reconstruction at Yale New Haven Hospital from 2013-2018. All modalities of breast reconstruction were included. Data collected includes demographic information, payer status, pre-operative medical and surgical history, and post-operative complications and outcomes. Results were stratified by academic and community-based plastic surgeons. Significance was established at p < 0.05. RESULTS: One thousand and forty five patients (1,658 breasts) underwent breast reconstruction in the study period. Eight hundred and eighty-nine breasts (52.8%) were performed by surgeons in academic practice while 794 breasts (47.2%) were performed by surgeons in community-based practice. Patient age and BMI were similar between the cohorts. However, patients cared for by academic surgeons were more likely to have a history of a psychiatric diagnosis (p=0.004), more frequent history of prior abdominal surgery (p<0.001), and a higher risk of diabetes approaching significance (p=0.064).. Furthermore, 32.8% fewer patients in the academic cohort had commercial insurance with 17.4% higher Medicaid (p<0.001) and 7.7% higher Medicare rates (p<0.001). Outcomes were similar between the groups, with identical 1.9% autologous flap failure rates, and no significant differences in unexpected return to the operating room in the first thirty postoperative days. However, community-based surgeons had a 1.9% higher infection rate (p < 0.027) as well as a 3.3% higher prosthetic failure / explantation rate (p < 0.003). CONCLUSIONS: Within our institution, academic and private-practice plastic surgeons perform microvascular breast reconstructions with similar complication profiles. Patients treated by academic surgeons have a higher rate of medical and psychiatric comorbidities, and fewer have commercial insurance. Patients treated by community surgeons have higher rates of infection and prosthetic failure.
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