Influence of hospital characteristics on immediate breast reconstruction following mastectomy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6118-6118
Author(s):  
Catherine A. Richards ◽  
Jason Dennis Wright ◽  
Alfred I. Neugut ◽  
Jeffrey Ascherman ◽  
Dawn L. Hershman
Keyword(s):  
Breast Reconstruction ◽  
Nationwide Inpatient Sample ◽  
Immediate Breast Reconstruction ◽  
Public And Private ◽  
The Mean ◽  
Insured Patients ◽  
Adjusted Model ◽  
Multivariable Adjusted Model ◽  
Hospital Characteristics ◽  
Privately Insured

6118 Background: Immediate breast reconstruction (IBR) following mastectomy is underutilized in the U.S. Racial, economic and geographic factors are associated with lower rates of IBR. Prior research has explored the association of individual and surgeon-level factors with the use of IBR, with little attention paid to hospital characteristics. Methods: We analyzed data from the 2008 Nationwide Inpatient Sample (NIS), a 20% random sample of academic, public and private U.S. hospitals. We used ICD-9 codes to identify women diagnosed with invasive breast cancer or DCIS who underwent mastectomy, and IBR (natural or expander/implant). If a hospital performed at least one IBR during 2008, they were classified as performing reconstruction. Relative risk regression was used to assess the hospital factors associated with a hospital performing IBR. Results: Of the 3,518 hospitals that performed mastectomy in 2008 only 50.4% performed at least one IBR. For hospitals that did not perform IBR, the average number of mastectomies was 5, compared to 35 at hospitals that did perform IBR (p<0.01). Among hospitals that did perform IBR, the mean proportion of mastectomy patients that had IBR was 34% (SD=20). In a multivariable adjusted model, urban/teaching (RR=3.47) and urban/non-teaching (RR=2.86) hospitals were significantly more likely to perform IBR compared to rural hospitals. Hospitals with a high proportion of privately insured patients (RR=1.10) were significantly more likely to perform IBR compared to hospitals with a low proportion of privately insured patients. In contrast, hospitals with a high proportion of publically insured patients (RR=0.24) and hospitals with a high proportion of female patients ≥ 70 years old (RR=0.75) were significantly less likely to perform IBR. Hospital region, hospital ownership status and the proportion of nonwhite patients were not significantly associated with IBR. Conclusions: Almost half of all U.S. hospitals where mastectomies are performed do not have any patients who have undergone IBR. The likelihood a hospital will perform IBR varies significantly by hospital characteristics.

scholarly journals Acute Myelogenous Leukemia: Insurance Status, Race and Comorbidities, but Not Distance from Treatment Center Determine Outcome

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3283-3283
Author(s):  
Samip Master ◽  
Zhenzhen Shi ◽  
Srinivas S. Devarakonda ◽  
Reinhold Munker ◽  
Runhua Shi
Keyword(s):  
Overall Survival ◽  
Treatment Outcomes ◽  
Treatment Delay ◽  
Myelogenous Leukemia ◽  
Insurance Status ◽  
Increased Risk ◽  
Facility Type ◽  
The Mean ◽  
Insured Patients ◽  
Privately Insured

Abstract Background: The treatment of acute myeloid leukemia (AML) has made major progress in the last 30 years. Well-known risk factors are age, cytogenetics and treatment intensity. Many other factors including access to healthcare modify treatment outcomes. According to smaller studies, the type of insurance (payer status) may or may not influence treatment outcomes. In the wake of the Affordable Care Act and its impact on insurance coverage, evaluating the effect of insurance status on health outcomes is urgently necessary. This study characterizes the relationship between payer status and overall survival for AML patients by analyzing data from the large National Cancer Data Base (NCDB). Methods: Data was analyzed from 67,443 men and women (≥ 18 years of age) registered in the NCDB who were diagnosed with AML between 1998 and 2011 and had follow-ups to end of 2012. The primary predictor variable was payer status and the outcome variable was overall survival. Additional variables addressed and adjusted for included sex, age, race, Charleson Comorbidity index, level of education, income, distance traveled, facility type, diagnosing/treating facility, treatment delay, and chemotherapy. Results: Among these 67,433 patients, the mean age at diagnosis was 61 years (median, 64 years) with a median survival of 7.98 months. The mean ages at diagnosis were 46.8, 51.8, 44.6, 73.6, and 57.9 years old for uninsured, private, Medicaid, Medicare and unknown payer status, respectively. In multivariate analysis, after adjusting for secondary predictor variables, payer status was a statistically significant predictor of overall survival from AML. Relative to privately insured patients, patients with Medicaid had a 17% increased risk, no insurance had a 21% increased risk, Medicare had a 19% increased risk, and unknown insurance had a 22% increased risk of mortality from AML. The percentage of patients surviving from AML after 24 months was 37.6%, 31.4%, 32.3%, 31.8%, and 33.1% for private, unknown, Medicare, uninsured, and Medicaid payer status, respectively. All factors investigated were found to be significant predictors of AML survival except distance travelled. Patients aged 65-74 were 2.9 times more likely to die compared to those aged 19-49. Patients who received chemotherapy were 22% less likely to die compared to those who did not. In the more recent time period (2005-2011 versus 1998- 2004, the prognosis of AML has improved, however the imbalance as per payer status did not change significantly. Conclusion: We observed that payer status has a statistically significant relationship with overall survival from AML. This remained true after adjusting for other predictive factors. Medicaid and uninsured patients had the highest mortality while privately insured patients had the lowest mortality. Further research is necessary how the disparities associated with different types of insurance result in inferior treatment outcomes and how they can be addressed. Multivariate Cox regression, hazard ratio of death by factorsTable 1.FactorLevelHR*LowerUpperAge18-491.0050-641.961.902.0265-742.862.752.9875+4.143.964.32InsurancePrivate1.00Uninsured1.211.141.28Medicaid1.161.111.21Medicare1.191.161.23Unknown1.231.151.31Year of diagnosis98-04105-110.850.820.87RaceWhite1.00Black1.081.041.12Asian0.920.860.98Charleson Comorbidity index01.0011.221.181.2621.491.421.56Unknown1.3521.3211.384ChemotherapyNo Chemo1Single Agent0.780.740.83Multiple Agent0.620.580.65*Adjusted for sex, income, education, distance traveled, facility type, diagnosing/treating facility, and treatment delay. Disclosures No relevant conflicts of interest to declare.

scholarly journals Triglyceride–glucose index is associated with the risk of myocardial infarction: an 11-year prospective study in the Kailuan cohort

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Xue Tian ◽  
Yingting Zuo ◽  
Shuohua Chen ◽  
Qian Liu ◽  
Boni Tao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Surrogate Marker ◽  
Tyg Index ◽  
Triglyceride Glucose Index ◽  
Increased Risk ◽  
The Mean ◽  
Adjusted Model ◽  
Multivariable Adjusted Model

Abstract Background The triglyceride–glucose (TyG) index, which is a simple surrogate marker of insulin resistance, has been suggested as a contributor of cardiovascular disease. However, evidence on the effect of long-term elevation of the TyG index exposure on myocardial infarction (MI) is limited. The current study aimed to evaluate the association of baseline and long-term elevation of the TyG index exposure with the risk of MI. Methods A total of 98,849 participants without MI at baseline (2006) were enrolled from the Kailuan study. The baseline TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The long-term TyG index was characterized in two ways as follows. The updated mean TyG index was calculated as the mean of TyG index at all previous visits before MI occurred or the end of follow-up; alternatively, the TyG index was calculated as the number of visits with a high TyG index in 2006, 2008, and 2010, ranging from 0 (no exposure) to 3 (had high TyG index at all three study visits). Hazard ratio (HR) and 95% confidence interval (CI) was estimated using multivariable Cox proportion hazard models. Results During a median follow-up of 11.03 years, 1555 incident MI occurred. In the multivariable-adjusted model, the risk of MI increased with quartiles of the baseline and updated mean TyG index, the HR in quartile 4 versus quartile 1 was 2.08 (95% CI,1.77–2.45) and 1.58 (1.18–2.12), respectively. Individuals with a high TyG index at all three visits had a 2.04-fold higher risk (95% CI, 1.63–2.56) of MI compared with no exposure. Subgroup analyses showed that the associations were more pronounced in women than in men (Pinteraction = 0.0411). Conclusions Elevated levels of the baseline and long-term TyG index are associated with an increased risk of MI. This finding indicates that the TyG index might be useful in identifying people at high risk of developing MI.

scholarly journals Stalled at the Intersection: Insurance Status and Disparities in Post Mastectomy Breast Reconstruction

2021 ◽  
Author(s):  
Orli Friedman-Eldar ◽  
Jonathan Burke ◽  
Iago de Castro Silva ◽  
Camille C Baumrucker ◽  
Fernando Valle ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Breast Reconstruction ◽  
Private Insurance ◽  
Safety Net ◽  
Insurance Status ◽  
Multivariable Logistic Regression ◽  
Safety Net Hospital ◽  
Insured Patients ◽  
Privately Insured

Abstract PurposePost-mastectomy breast reconstruction (PMBR) is an important component of breast cancer treatment, but disparities relative to insurance status persist despite legislation targeting the issue. We aimed to study this relationship in a large health system combining a safety net hospital and a private academic center.MethodsData were collected on all patients who underwent mastectomy for breast cancer from 2011-2019 in a private academic center and an adjacent public safety-net hospital served by same surgical teams. Multivariable logistic regression was used to assess the effect of insurance status on PMBR, controlling for covariates that included socioeconomic, demographic, and clinical factors.ResultsOf 1,554 patients undergoing mastectomy for breast cancer, 753 (48.5%) underwent PMBR. Out of them, 741 had insurance type recorded, with 592 (79.9%) privately insured patients, 50 (6.7%) Medicare, 68 (9.2%) Medicaid, and 31 (4.2%) uninsured patients. Multivariable logistic regression showed a significantly lower likelihood of undergoing PMBR for uninsured (OR 6.9, 95% CI: 4.1-11.7; p<0.0001), Medicare (OR 2.0, (5% CI: 1.2-3.3; p=0.004), and Medicaid (OR 1.7, 95% CI:1.1-2.7; p=0.02) patients, compared with privately insured patients. Age, stage, race, and hospital type confounded this relationship.ConclusionPatients without health insurance have dramatically reduced access to PMBR compared to those with private insurance. Expanding access to this important procedure is essential to achieve greater health equity for breast cancer patients.

Prepectoral Implant-Based Breast Reconstruction Using Meshed ADM

2020 ◽  
pp. 229255032093368
Author(s):  
Alessandra Fin ◽  
Fabrizio De Biasio ◽  
Sebastiano Mura ◽  
Samuele Massarut ◽  
Giovanna Zaccaria ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Normal Skin ◽  
Case Series ◽  
Acellular Dermal Matrix ◽  
Immediate Breast Reconstruction ◽  
Dermal Matrix ◽  
Scale Scores ◽  
The Mean ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Prepectoral prosthetic breast reconstruction has been widely reassessed in recent years and is taking on an increasingly important role in the field of immediate breast reconstruction. We report here a case series of 32 patients who underwent nipple-sparing mastectomy for breast carcinoma and prepectoral breast reconstruction involving an acellular dermal matrix (ADM) treated by means of a skin-graft mesher in our hospital from January 2015 to March 2016. The indications for this type of reconstruction were body mass index (BMI) less than 30 kg/m2; no history of radiotherapy; no active smokers; moderate grade breast; and good viability of mastectomy flap: normal skin colour, active bleeding at the fresh cut edges, and thicker than 1 cm mastectomy flaps; the viability of lower thicknesses was ascertained by the fluorescent dye indocyanine green xenon-based imaging technology (4 patients). The mean age of the patients was 56.4 years (range: 39-77 years). Their mean BMI was 27.4 kg/m2. Until the end of follow-up (mean: 17 months), major complications requiring reoperation occurred in 9% of patients and minor complications in 22% of patients. The mean of the 3 pain visual analogue scale scores taken in the first 24 hours after surgery was 1.8. Mean duration of hospital stay has been 2.2 days. Our complication rate was similar to those reported in other studies on prepectoral breast reconstruction featuring total ADM coverage of the implant.

scholarly journals Association of the insulinemic potential of diet and lifestyle with risk of diabetes incident in Tehranian adults: a population based cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Hossein Farhadnejad ◽  
Ebrahim Mokhtari ◽  
Farshad Teymoori ◽  
Mohammad Hassan Sohouli ◽  
Nazanin Moslehi ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Population Based ◽  
Dietary Intakes ◽  
Dietary Index ◽  
Increased Risk ◽  
The Mean ◽  
Adjusted Model ◽  
Diet And Lifestyle ◽  
Multivariable Adjusted Model

Abstract Background We aimed to assess the associations between insulinemic potential of diet and lifestyle and the risk of diabetes incident, using four empirical indices including the empirical dietary index for hyperinsulinemia (EDIH), the empirical dietary index for insulin resistance (EDIR), empirical lifestyle index for hyperinsulinemia (ELIH), and empirical lifestyle index for insulin resistance (ELIR). Methods A total of 3734 individuals, aged ≥ 20 years old, who were free of diabetes at baseline (2008–2011), were followed for 6.2 years (2015–2018) to ascertain incident diabetes. The food frequency questionnaire was used to collect dietary intakes at baseline. Odds ratio (OR) of diabetes were calculated across quartiles of EDIH, EDIR, ELIH, and ELIR using logistic regression, which controlled for confounding factors. Results The mean ± SD age and BMI of individuals (45.1 % male) were 40.9 ± 12.0 years and 27.1 ± 4.1 kg/m2, respectively. At the end of follow-up, 253 (6.8 %) diabetes cases were identified. In the multivariable-adjusted model, individuals in the highest quartile of EDIR (1.58;95 %CI:1.03–2.44, P for trend = 0.025), ELIH (1.89;95 %CI:1.20–2.97, P for trend = 0.004), and ELIR (1.74; 95 %CI:1.11–2.72, P for trend = 0.031) had increased the risk of diabetes. However, no significant associations were found between the score of EDIH and diabetes incident. Conclusions Higher adherence to EDIR, ELIH, and ELIR scores were associated with increased risk of diabetes, while no significant association was found between EDIH score and diabetes incident.

scholarly journals Increasing Out-of-Pocket Costs for Neurologic Care for Privately-Insured Patients

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011278
Author(s):  
Chloe E. Hill ◽  
Evan L. Reynolds ◽  
James F. Burke ◽  
Mousumi Banerjee ◽  
Kevin A. Kerber ◽  
...  
Keyword(s):  
Cost Sharing ◽  
Diagnostic Testing ◽  
Service Cost ◽  
Number Of Patients ◽  
The Mean ◽  
Insured Patients ◽  
High Deductible Health Plan ◽  
The Cost ◽  
Out Of Pocket Costs ◽  
Privately Insured

Objective:To measure the out-of-pocket costs of evaluation and management (E/M) services and common diagnostic testing for neurology patients.Methods:Utilizing a large, privately-insured healthcare claims database, we identified patients with a neurologic visit or diagnostic test from 2001-2016 and assessed inflation-adjusted out-of-pocket costs for E/M visits, neuroimaging, and neurophysiologic testing. For each diagnostic service each year, we estimated the proportion of patients with out-of-pocket costs, the mean out-of-pocket cost, and the proportion of the total service cost paid out-of-pocket. We modeled out-of-pocket cost as a function of patient and insurance factors.Results:We identified 3,724,342 patients. The most frequent neurologic services were E/M visits (78.5%), electromyogram/nerve conduction studies (EMG/NCS) (7.7%), MRIs (5.3%), and electroencephalograms (EEGs) (4.5%). Annually, 86.5-95.2% of patients paid out-of-pocket costs for E/M visits and 23.1-69.5% for diagnostic tests. For patients paying any out-of-pocket cost, the mean out-of-pocket cost increased over time, most substantially for EEG, MRI, and E/M. Out-of-pocket costs varied considerably; for an MRI in 2016, the 50th percentile paid $103.1 and the 95th percentile paid $875.4. The proportion of total service cost paid out-of-pocket increased. High deductible health plan (HDHP) enrollment was associated with higher out-of-pocket costs for MRI, EMG/NCS, and EEG.Conclusions:An increasing number of patients pay out-of-pocket for neurologic diagnostic services. These costs are rising and vary greatly across patients and tests. The cost sharing burden is particularly high for the growing population with HDHPs. In this setting, neurologic evaluation might result in financial hardship for patients.

Complications in immediate breast reconstruction after mastectomy

2011 ◽  
Vol 27 (4) ◽  
pp. 298-304 ◽  
Author(s):  
Alberto Jiménez-Puente ◽  
Elisa Prieto-Lara ◽  
Antonio Rueda-Domínguez ◽  
Claudio Maañón-Di Leo ◽  
Nicolás Benítez-Parejo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Neoadjuvant Chemotherapy ◽  
Breast Reconstruction ◽  
Predictive Model ◽  
Significant Proportion ◽  
Immediate Breast Reconstruction ◽  
Cox's Regression ◽  
The Mean

Objectives: Immediate post-mastectomy breast reconstruction (IBR) is a procedure that has proven advantages, but it also entails risks. The aim of this study was to identify risk factors for reconstruction failure.Methods: A review was made of all the IBR carried out at a general hospital from 2002 to 2009. Retrospective information was obtained about postoperative complications and the characteristics of patients and treatments applied. The minimum follow-up period was 9 months. Cox's regression analysis was performed on the variables related to the reconstruction failure requiring the removal of the prosthesis, with an explanatory model in which all the study variables were introduced and a predictive model that contained only the variables known before the intervention.Results: A total of 115 IRB interventions carried out on 112 women with breast cancer were analyzed. The mean follow-up period was 25.5 months. In sixty cases (52.2 percent), there were no complications; in sixteen cases (13.9 percent) minor complications appeared, and in 39 (33.9 percent) the complications were moderate. In twenty-six cases (22.6 percent), a reconstruction failure occurred. Cox's regression model revealed that the reconstruction failures were related to the patient's age (Hazard Ratio 1.08), to neoadjuvant chemotherapy (HR 6.24) and to postoperative tamoxifen (HR 3.10). The predictive model included the age of the patient (HR 1.05) and the use of neoadjuvant chemotherapy (HR 5.11).Conclusions: A significant proportion of the patients receiving IBR developed reconstruction failure. Multivariate analysis identified three variables related to this complication, two of which were known before the intervention.

Immediate Breast Reconstruction with Stacked Diep Flap

2014 ◽  
Vol 30 (S 01) ◽  
Author(s):  
Carmen Suñé ◽  
David Carrillo ◽  
Cristian Lopez ◽  
Marco Serena Signes ◽  
Alejandra Sainz ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Immediate Breast Reconstruction ◽  
Diep Flap
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