Huang Anne, Koesters Emma, Garza Rebecca M, Hanson Summer E, Chang David W
Section of Plastic and Reconstructive Surgery, University of Chicago Medicine & Biological Sciences, Chicago, Illinois, USA.
Rebecca Garza Plastic Surgery, Schererville, Indiana, USA.
J Surg Oncol. 2025 Jun;131(7):1393-1399. doi: 10.1002/jso.28067. Epub 2024 Dec 29.
Immediate lymphatic reconstruction (ILR) performed to prevent breast cancer related lymphedema is not consistently covered by insurance payors in the United States.
Retrospective review was performed on a prospective database of ILR candidates from 2018 to 2022. Candidates were identified as patients with clinical axillary lymph node involvement at the time of breast cancer diagnosis. Patient demographics, insurance type, and development of lymphedema were recorded.
One hundred and eighty ILR candidates were identified, 50 of whom underwent ILR. Non-ILR patients were more likely to be of black race, have Medicaid health insurance, earn lower median household income, and have lower rates of out-of-pocket payment when not covered by insurance. In 40 cases where ILR was indicated but not performed, 55% were due to financial reasons. After a minimum of 1 year follow up, 14.6% (6/41) of patients who underwent ILR had lymphedema, compared with 12.5% (9/72) of patients who had no clinical indication for ILR and 40% (10/25) of patients who did not undergo ILR when clinically indicated (p = 0.012).
Disparities in insurance coverage and financial resources may adversely impact access and outcomes in patients clinically indicated for ILR.
为预防乳腺癌相关淋巴水肿而进行的即时淋巴重建（ILR）在美国并未得到保险支付方的一致覆盖。
对2018年至2022年ILR候选者的前瞻性数据库进行回顾性分析。候选者被确定为乳腺癌诊断时临床腋窝淋巴结受累的患者。记录患者人口统计学信息、保险类型和淋巴水肿的发生情况。
确定了180名ILR候选者，其中50人接受了ILR。未接受ILR的患者更可能是黑人，拥有医疗补助医疗保险，家庭收入中位数较低，且在未被保险覆盖时自付费用率较低。在40例有ILR指征但未进行的病例中，55%是由于经济原因。经过至少1年的随访，接受ILR的患者中有14.6%（6/41）发生了淋巴水肿，而无ILR临床指征的患者中有12.5%（9/72）发生了淋巴水肿，有临床指征但未接受ILR的患者中有40%（10/25）发生了淋巴水肿（p = 0.012）。
保险覆盖范围和财务资源的差异可能会对有ILR临床指征的患者的可及性和治疗结果产生不利影响。
