Buckley Elaine Jayne, Zahnd Whitney E, Rea David J, Mellinger John D, Ganai Sabha
Department of Surgery, Southern Illinois University School of Medicine, Springfield, USA.
Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA.
Am J Surg. 2017 Oct;214(4):645-650. doi: 10.1016/j.amjsurg.2017.06.014. Epub 2017 Jun 29.
Disparities in access to care exist for breast cancer patients, including access to surgeons performing reconstruction. We hypothesized rural patients have delayed time to surgery after mastectomy with reconstruction with implications on survival.
An observational study was conducted using the National Cancer Database on patients with breast cancer from 2003 to 2007 who underwent mastectomy, with or without reconstruction from 2003 to 2007 (n = 90,319).
Patients with, and without, reconstruction varied by demographics, facility type and stage. Time to surgery was longer for mastectomy with reconstruction. Unadjusted analysis demonstrated marginally decreased survival for rural patients undergoing mastectomy alone but not for mastectomy with reconstruction. Cox proportional hazards analysis revealed no significant differences by rural-urban status, but a survival advantage was seen after mastectomy with reconstruction, which persisted up to a delay of 180 days.
Patients who underwent reconstruction had improved survival. Time to surgery is shorter for rural patients (for all types of mastectomy). We found no significant rural-urban disparity in survival.
乳腺癌患者在获得医疗服务方面存在差异，包括获得进行重建手术的外科医生的机会。我们假设农村患者在乳房切除术后进行重建的手术时间会延迟，这对生存有影响。
利用国家癌症数据库对2003年至2007年接受乳房切除术（无论是否进行重建）的乳腺癌患者进行了一项观察性研究（n = 90319）。
进行重建和未进行重建的患者在人口统计学、医疗机构类型和分期方面存在差异。乳房切除术后进行重建的手术时间更长。未经调整的分析表明，仅接受乳房切除术的农村患者生存率略有下降，但接受乳房切除术后进行重建的患者则没有。Cox比例风险分析显示，城乡状况没有显著差异，但乳房切除术后进行重建的患者有生存优势，这种优势一直持续到延迟180天。
接受重建手术的患者生存率有所提高。农村患者（所有类型的乳房切除术）的手术时间较短。我们发现城乡在生存方面没有显著差异。
