Flitcroft K L, Brennan M E, Costa D S J, Spillane A J
Breast and Surgical Oncology at the Poche Centre University of Sydney Sydney Australia.
Northern Clinical School University of Sydney Sydney Australia.
BJS Open. 2017 Oct 26;1(4):114-121. doi: 10.1002/bjs5.19. eCollection 2017 Aug.
Breast reconstruction following mastectomy has proven benefits and is the standard of care in many high-income countries. This audit documented regional variation in immediate breast reconstruction rates across Australia.
The Breast Surgeons of Australia and New Zealand (BreastSurgANZ) Quality Audit database and geospatial software were used to model the distribution of breast reconstructions performed on women having mastectomy in Australia in 2013. Geospatial mapping identified the distribution of these procedures in relation to the Greater Capital City Statistical Areas (GCCSAs) of the five largest states. Data were analysed using χ tests of independence and an independent-samples t test.
Of 3786 patients having a mastectomy, 692 underwent breast reconstruction of which 679 (98·1 per cent) were immediate reconstructions. Rates of reconstruction differed significantly between jurisdictions (χ = 164·90), and were significantly higher in GCCSAs (χ = 144·60) and private hospitals (χ = 50·72) (all P < 0·001). Immediate breast reconstruction was not reported for 43·8 per cent of hospitals where mastectomy was conducted by members of BreastSurgANZ, including 29·8 per cent of hospitals within GCCSAs. A wider age range of women appeared to have had immediate reconstructions at hospitals within GCCSAs, although the difference in mean age between regions was not significant. Immediate breast reconstruction was considerably less likely to be performed in women who lived in areas of lower to mid socioeconomic status.
Variations in the rate of immediate breast reconstruction may not be purely resource-driven.
乳房切除术后进行乳房重建已被证明有益，并且在许多高收入国家是护理标准。本次审计记录了澳大利亚即刻乳房重建率的地区差异。
利用澳大利亚和新西兰乳房外科医生（BreastSurgANZ）质量审计数据库和地理空间软件，对2013年澳大利亚接受乳房切除术的女性所进行的乳房重建分布情况进行建模。地理空间映射确定了这些手术相对于五个最大州的大首府城市统计区（GCCSA）的分布。使用独立性χ检验和独立样本t检验对数据进行分析。
在3786例接受乳房切除术的患者中，692例进行了乳房重建，其中679例（98.1%）为即刻重建。各辖区之间的重建率差异显著（χ = 164.90），在GCCSA（χ = 144.60）和私立医院（χ = 50.72）中重建率显著更高（所有P < 0.001）。在BreastSurgANZ成员进行乳房切除术的43.8%的医院中未报告即刻乳房重建，包括GCCSA内29.8%的医院。在GCCSA内的医院，似乎有更广泛年龄范围的女性进行了即刻重建，尽管各地区之间的平均年龄差异不显著。社会经济地位较低至中等地区的女性进行即刻乳房重建的可能性要小得多。
即刻乳房重建率的差异可能并非纯粹由资源驱动。
