面部重建手术商业市场份额的下降：对整形外科学术和培训下一代的影响。
Declining commercial market share in facial reconstructive surgery: Implications for academic plastic surgery and training future generations.
机构信息
Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, United States; Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
出版信息
J Plast Reconstr Aesthet Surg. 2022 Dec;75(12):4484-4493. doi: 10.1016/j.bjps.2022.08.071. Epub 2022 Aug 27.
BACKGROUND
As a surgical discipline without anatomic boundaries, plastic surgery overlaps with several other specialties. This study aims to measure longitudinal trends in the proportion of commercially reimbursed procedures performed by plastic surgeons compared to other specialists. We hypothesize that there is encroachment in commercial market share by anatomically defined subspecialists within otolaryngology, ophthalmology, and dermatology.
METHODS
The IBM® MarketScan® Research Databases were queried to extract patients who underwent rhinoplasty, eyelid procedures, and skin cancer reconstruction covered by commercial insurance from 2007 to 2016 in the USA. Surgeon specialty was identified. Poisson regression modeled predictors of provider specialty for each procedure over time, adjusting for patient gender, region, facility setting, and diagnosis.
RESULTS
A total of 430,472 rhinoplasty, eyelid, and skin cancer procedures were performed during the study period. For each year, the proportion of cases performed by plastic surgeons decreased by 2.1% for rhinoplasty compared to otolaryngologists, 2.0% for eyelid procedures compared to ophthalmologists, and 3.0% for skin cancer reconstruction compared to dermatologists (p<0.001). Plastic surgeons were less likely to perform the procedure if the underlying diagnosis or preceding procedure drew from referral bases of "anatomic" specialists, such as sinonasal disease for otolaryngologists (incidence rate ratio [IRR] 0.829), disorders of the eyelid or orbit for ophthalmologists (IRR 0.646), and Mohs excision for dermatologists (IRR 0.381) (p<0.001).
CONCLUSIONS
Plastic surgeons are losing ground on commercially reimbursed facial reconstructive procedures historically performed by the specialty. Plastic surgeons must develop strategies to preserve the commercial market share of these procedures and avoid compromise to academic centers and resident education.
背景
作为一门没有解剖学界限的外科学科，整形外科学与其他几个专业领域重叠。本研究旨在衡量与耳鼻喉科、眼科和皮肤科的解剖学定义亚专业相比，整形外科医生进行商业报销手术的比例的纵向趋势。我们假设，在商业市场份额方面，这些亚专业存在侵蚀现象。
方法
通过 IBM® MarketScan® Research Databases 在美国检索了 2007 年至 2016 年期间接受商业保险覆盖的鼻整形术、眼睑手术和皮肤癌重建的患者数据。确定了外科医生的专业。泊松回归模型根据患者性别、地区、医疗机构设置和诊断，对每种手术的时间预测变量进行了调整，以预测提供者专业。
结果
在研究期间共进行了 430,472 例鼻整形术、眼睑和皮肤癌手术。与耳鼻喉科医生相比，每年整形外科医生进行的鼻整形术的比例下降了 2.1%，与眼科医生相比，进行的眼睑手术的比例下降了 2.0%，与皮肤科医生相比，进行的皮肤癌重建的比例下降了 3.0%（p<0.001）。如果潜在的诊断或之前的手术来自“解剖”专家的转诊基础，例如耳鼻喉科医生的鼻窦疾病（发病率比 [IRR] 0.829）、眼科医生的眼睑或眼眶疾病（IRR 0.646）和皮肤科医生的 Mohs 切除术（IRR 0.381），则整形外科医生进行手术的可能性较小（p<0.001）。
结论
整形外科医生在商业报销的面部重建手术方面正在失去优势，这些手术传统上由该专业完成。整形外科医生必须制定策略来保护这些手术的商业市场份额，并避免对学术中心和住院医师教育造成影响。
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