From the Division of Plastic and Reconstructive Surgery, Columbia University Irving Medical Center.
Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY.
Ann Plast Surg. 2023 Jun 1;90(6S Suppl 5):S598-S606. doi: 10.1097/SAP.0000000000003490. Epub 2023 Feb 18.
Immediate postmastectomy breast reconstruction plays an integral role in patient care because of its psychosocial benefits. New York State (NYS) passed the 2010 Breast Cancer Provider Discussion Law with the aim of increasing patient awareness of reconstructive options through mandating plastic surgery referral at the time of cancer diagnosis. Short-term analysis of the years surrounding implementation suggests the law increased access to reconstruction, especially for certain minority groups. However, given the continued presence of disparities in access to autologous reconstruction, we aimed to investigate the longitudinal effects of the bill on access to autologous reconstruction along various sociodemographic cohorts.
Retrospective review identified demographic, socioeconomic, and clinical data for patients undergoing mastectomy with immediate reconstruction at Weill Cornell Medicine and Columbia University Irving Medical Center from 2002 to 2019. Primary outcome was receiving implant or autologous-based reconstruction. Subgroup analysis was based on sociodemographic factors. Multivariate logistic regression identified predictors of autologous reconstruction. Interrupted time series modeling analyzed differences in reconstructive trends for subgroups before and after the 2011 implementation of the NYS law.
We included 3178 patients; 2418 (76.1%) and 760 (23.9%) patients underwent implant and autologous-based reconstruction, respectively. Multivariate analysis indicated that race, Hispanic status, and income were not predictors of autologous reconstruction. Interrupted time series showed that with each year leading up to 2011 implementation, patients were 19% less likely to receive autologous-based reconstruction. Following implementation, there was a 34% increase in the odds of receiving autologous-based reconstruction with each passing year. Following implementation, Asian American and Pacific Islander patients experienced a 55% greater increase in the rate of flap reconstruction than White patients. Following implementation, the highest-income quartile experienced a 26% greater increase in the rate of autologous-based reconstruction compared with the lowest-income quartile. After implementation, Hispanic patients experienced a 30% greater decrease in the rate of autologous-based reconstruction compared with non-Hispanic patients.
Our data indicate the long-term efficacy of the NYS Breast Cancer Provider Discussion Law in increasing access to autologous-based reconstruction, especially for certain minority groups. These findings underscore the importance of this bill and encourage its adoption into other states.
即刻乳房重建术在患者护理中起着重要作用，因为它具有心理社会益处。纽约州（NYS）于 2010 年通过了《乳腺癌提供者讨论法》，旨在通过在癌症诊断时强制转介整形外科来提高患者对重建选择的认识。对实施前后几年的短期分析表明，该法律增加了重建的机会，特别是对某些少数群体而言。然而，鉴于在接受自体重建方面仍然存在差异，我们旨在调查该法案对各种社会人口队列中接受自体重建机会的长期影响。
回顾性分析了 2002 年至 2019 年在威尔·康奈尔医学院和哥伦比亚大学欧文医学中心接受即刻乳房切除术和重建术的患者的人口统计学、社会经济和临床数据。主要结果是接受植入物或自体重建。亚组分析基于社会人口统计学因素。多变量逻辑回归确定了自体重建的预测因素。中断时间序列分析用于分析 2011 年 NYS 法律实施前后亚组重建趋势的差异。
我们纳入了 3178 例患者；2418 例（76.1%）和 760 例（23.9%）患者分别接受了植入物和自体重建。多变量分析表明，种族、西班牙裔身份和收入不是自体重建的预测因素。中断时间序列显示，在 2011 年实施之前的每一年，患者接受自体重建的可能性降低 19%。实施后，每年接受自体重建的可能性增加 34%。实施后，与白人患者相比，亚裔美国人和太平洋岛民患者接受皮瓣重建的比例增加了 55%。实施后，收入最高的四分位数与收入最低的四分位数相比，自体重建的比例增加了 26%。实施后，与非西班牙裔患者相比，西班牙裔患者接受自体重建的比例下降了 30%。
我们的数据表明，纽约州《乳腺癌提供者讨论法》在增加自体重建机会方面具有长期效果，特别是对某些少数群体。这些发现强调了该法案的重要性，并鼓励其他州采用该法案。
