Ann Arbor, Mich.; and Iowa City, Iowa From the Section of Plastic Surgery, Department of Surgery, and the Departments of General Medicine and Internal Medicine, The University of Michigan Medical Center; the Department of General Surgery, St. Joseph Mercy Hospital; the Department of General Surgery, University of Iowa; and the Ann Arbor Veterans Affairs Center for Clinical Management Research.
Plast Reconstr Surg. 2011 May;127(5):1796-1803. doi: 10.1097/PRS.0b013e31820cf183.
: Concern exists that plastic surgeons have lost interest in postmastectomy breast reconstruction, which has helped enable the oncoplastic movement by general surgery. The authors evaluated patterns and correlates of postmastectomy breast reconstruction among U.S. plastic surgeons.
A survey was mailed to a national sample of 500 randomly selected members of the American Society of Plastic Surgeons (73 percent of eligible subjects responded; n = 312). The dependent variable was surgeon's annual volume of breast reconstructions (dichotomized into >50 and ≤ 50 cases per year). Logistic regression was used to evaluate factors associated with annual volume, including surgeon demographic and practice characteristics, community support for reconstruction, and surgeons' attitudes toward insurance reimbursement.
Ninety percent found doing breast reconstruction personally rewarding, and nearly all enjoyed the technical aspects of the procedure. The majority of surgeons, however, were low-volume to moderate-volume providers, and 43 percent reported decreasing their volume over the past year due to poor reimbursement. Resident availability was significantly associated with high volume (odds ratio, 4.93; 95 percent CI, 2.31 to 10.49); years in practice and perceived financial constraints by third-party payers were inversely associated with high volume (>20 years compared with ≤ 10 years: odds ratio, 0.23. 95 percent CI, 0.07 to 0.71; odds ratio, 0.22, 95 percent CI, 0.08 to 0.56, respectively).
Although plastic surgeons find breast reconstruction professionally rewarding, many are decreasing their practice. Factors associated with low volume include lack of resident coverage and perceived poor reimbursement. Advocacy efforts must be directed at facilitating reconstructive services for this highly demanding patient population.
人们担心整形外科医生对乳房再造术失去兴趣，而乳房再造术正是推动普通外科开展肿瘤整形手术的关键。作者评估了美国整形外科医生乳房再造术的模式和相关因素。
一项调查以邮寄的方式发给了美国整形外科学会（ASPS）500 名随机抽取的成员中的 500 名（73%的合格对象做出了回应；n = 312）。因变量为外科医生每年乳房重建的数量（分为每年>50 例和≤50 例）。使用逻辑回归来评估与每年数量相关的因素，包括外科医生的人口统计学和实践特征、社区对重建的支持，以及外科医生对保险报销的态度。
90%的医生认为做乳房重建是个人的回报，并且几乎所有医生都喜欢该手术的技术方面。然而，大多数外科医生是低容量到中等容量的提供者，并且 43%的医生报告说由于报销不佳，他们在过去一年中减少了手术量。住院医师的可用性与高容量显著相关（优势比，4.93；95%置信区间，2.31 至 10.49）；执业年限和第三方付款人认为的经济限制与高容量呈反比（>20 年与≤10 年：优势比，0.23；95%置信区间，0.07 至 0.71；优势比，0.22；95%置信区间，0.08 至 0.56）。
尽管整形外科医生认为乳房重建是有意义的，但许多医生正在减少他们的手术量。低容量的相关因素包括缺乏住院医师覆盖和认为报销不佳。必须努力倡导为这一高需求的患者群体提供重建服务。
