Fox Justin P, Latham Kerry P, Darmon Sarah, Eaglehouse Yvonne L, Bytnar Julie A, Shriver Craig D, Zhu Kangmin
From the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
Ann Plast Surg. 2025 Jan 1;94(1):20-25. doi: 10.1097/SAP.0000000000004077. Epub 2024 Sep 11.
In the Military Health System (MHS), women with breast cancer may undergo surgical treatment in military hospitals (direct care) or in the civilian setting via the insurance benefit (private sector care). We conducted this study to determine immediate breast reconstruction rates among women undergoing mastectomy for cancer in the MHS by setting of care.
Using the linked Department of Defense's Central Cancer Registry and MHS Data Repository, the Department of Defense's medical claims database, we identified adult women who underwent mastectomy for breast cancer from 1998 to 2014. Patients were then subgrouped by setting of care (direct vs private sector care). The primary outcome was the rate and type of immediate breast reconstruction. Regression models were constructed to determine factors associated with receipt of immediate breast reconstruction.
The final sample included 3251 women who underwent mastectomy for cancer in the direct (67.0%) or private sector care (32.6%) settings. The overall rate of immediate breast reconstruction was 29.9% with an upward trend noted throughout the study ( P < 0.001). Overall, implant-based reconstruction (81.4%) was more common than tissue-based reconstruction (18.6%). Compared with direct care, the immediate breast reconstruction rate was significantly higher in the private sector care setting (49.3% vs 20.5%, P < 0.001) despite accounting for differences in clinical characteristics (adjusted odds ratio = 4.51, 95% confidence interval [3.72-5.46]).
Immediate breast reconstruction in the direct care setting lags that in the civilian community during the study time period. Further research is needed to ascertain current immediate reconstruction rates and understand factors contributing to any differences in rates between care settings.
在军事卫生系统（MHS）中，患有乳腺癌的女性可能在军事医院接受手术治疗（直接护理），或通过保险福利在 civilian 机构接受治疗（私营部门护理）。我们开展这项研究，以确定在 MHS 中接受癌症乳房切除术的女性按护理机构划分的即刻乳房重建率。
利用国防部中央癌症登记处和 MHS 数据存储库的关联数据、国防部医疗索赔数据库，我们确定了 1998 年至 2014 年期间接受乳腺癌乳房切除术的成年女性。然后，患者按护理机构（直接护理与私营部门护理）进行分组。主要结局是即刻乳房重建的率和类型。构建回归模型以确定与接受即刻乳房重建相关的因素。
最终样本包括 3251 名在直接护理（67.0%）或私营部门护理（32.6%）机构接受癌症乳房切除术的女性。即刻乳房重建的总体率为 29.9%，在整个研究过程中呈上升趋势（P < 0.001）。总体而言，基于植入物的重建（81.4%）比基于组织的重建（18.6%）更常见。与直接护理相比，私营部门护理机构的即刻乳房重建率显著更高（49.3%对 20.5%，P < 0.001），尽管考虑了临床特征的差异（调整后的优势比 = 4.51，95%置信区间[3.72 - 5.46]）。
在研究期间，直接护理机构的即刻乳房重建落后于 civilian 社区。需要进一步研究以确定当前的即刻重建率，并了解导致不同护理机构之间重建率差异的因素。
