Iskandar Mazen E, Dayan Erez, Lucido David, Samson William, Sultan Mark, Dayan Joseph H, Boolbol Susan K, Smith Mark L
New York, N.Y. From the Department of Surgery, Divisions of General Surgery, Biostatistics, Plastic Surgery, and Breast Surgery, Beth Israel Medical Center.
Plast Reconstr Surg. 2015 Feb;135(2):270e-276e. doi: 10.1097/PRS.0000000000000888.
On January 1, 2011, New York State amended the Public Health Law to ensure that patients receive "information and access to breast reconstruction surgery." The purposes of this study were to investigate the early impact of this legislation on reconstruction rates and to evaluate the influence of patient variables versus physician variables on the incidence and type of breast reconstruction performed.
A retrospective study was conducted on all patients who underwent mastectomy between January 1, 2010, and December 31, 2011. Reconstruction rates were analyzed in relation to timing of legislation, breast surgeon variables, plastic surgeon faculty status, type of reconstruction, and patient variables.
Two hundred fifty-eight patients met inclusion criteria. The overall reconstruction rate was 56.59 percent. There was no statistically significant increase in reconstruction rate after the 2011 legislation (OR, 0.45; p = 0.057). Patients whose breast surgeon was female were more likely to undergo reconstruction (OR, 5.17; p = 0.001). Patients who were Asian (OR, 0.22; p = 0.002), older than 60 years (OR, 0.09; p = 0.001), or had stage 3 and 4 cancer (OR, 0.04; p = 0.03) were less likely to undergo reconstruction. Patients reconstructed by a hospital-employed plastic surgeon were significantly more likely to undergo autologous versus implant reconstruction (OR, 6.85; p = 0.001) and to undergo microsurgical versus nonmicrosurgical autologous reconstruction (78.2 percent versus 0 percent; p = 0.001).
Breast surgeon sex and plastic surgeon faculty status were the factors that most affected the rate and type of reconstruction, respectively. Legislation mandating the discussion of breast reconstruction options had no impact on reconstruction rate.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
2011年1月1日，纽约州修订了《公共卫生法》，以确保患者能够获得“乳房重建手术的信息并可接受该手术”。本研究的目的是调查该立法对重建率的早期影响，并评估患者变量与医生变量对乳房重建的发生率和类型的影响。
对2010年1月1日至2011年12月31日期间接受乳房切除术的所有患者进行回顾性研究。分析重建率与立法时间、乳房外科医生变量、整形外科医生职称、重建类型和患者变量之间的关系。
258例患者符合纳入标准。总体重建率为56.59%。2011年立法后重建率没有统计学上的显著增加（比值比，0.45；p = 0.057）。乳房外科医生为女性的患者更有可能接受重建（比值比，5.17；p = 0.001）。亚洲患者（比值比，0.22；p = 0.002）、60岁以上患者（比值比，0.09；p = 0.001）或患有3期和4期癌症的患者（比值比，0.04；p = 0.03）接受重建的可能性较小。由医院聘用的整形外科医生进行重建的患者接受自体重建而非植入物重建的可能性显著更高（比值比，6.85；p = 0.001），并且接受显微外科自体重建而非非显微外科自体重建的可能性也更高（78.2%对0%；p = 0.001）。
乳房外科医生的性别和整形外科医生的职称分别是最影响重建率和重建类型的因素。强制讨论乳房重建选择的立法对重建率没有影响。
临床问题/证据水平：风险，II级。
