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A Nationwide Analysis of the Relationship between Hospital Volume and Outcome for Autologous Breast Reconstruction

Albornoz, Claudia R. M.D., M.Sc.; Cordeiro, Peter G. M.D.; Hishon, Lauren; Mehrara, Babak J. M.D.; Pusic, Andrea L. M.D., M.H.S.; McCarthy, Colleen M. M.D., M.S.; Disa, Joseph J. M.D.; Matros, Evan M.D., M.M.Sc.

Plastic and Reconstructive Surgery: August 2013 - Volume 132 - Issue 2 - p 192e–200e
doi: 10.1097/PRS.0b013e31829586c1
Breast: Outcomes Articles
Basic

Background: The volume-outcome relationship has not been specifically measured for U.S. autologous breast reconstruction. The authors studied whether there is a relationship between hospital procedural volume and perioperative complication rates.

Methods: The authors identified (1) patients who underwent total mastectomy with immediate autologous reconstruction from 1998 to 2010 and (2) a subset of microsurgical cases from 2008 to 2010. Hospitals were categorized into quartiles based on number of yearly procedures. Outcomes included surgery-specific and systemic complications. A multivariable model was used to analyze the volume-outcome relationship after adjusting for other variables.

Results: Over the 13-year study period, 21,016 immediate autologous reconstructions were recorded. Surgery-specific and systemic complication rates were 13.0 and 7.5 percent, respectively. Ninety-two percent of centers perform a very low (fewer than nine cases per year) or low (nine to 20 cases per year) number of procedures. The highest-volume centers (>44 cases per year) are located in metropolitan areas. An inverse relationship between reconstructive volume and surgery-specific and systemic complications was identified (p < 0.01). In the multivariable analysis, centers with very low, low, and medium case volumes were more likely to have surgery-specific complications than high-volume centers (p < 0.01). Very-low-volume compared with high-volume centers were more likely to have systemic complications (p < 0.01).

Conclusions: Higher volume autologous breast reconstruction centers have lower complication rates. The volume-outcome relationship is stronger for surgery-specific than for systemic complications. Geographic disparities are present in the distribution of high-volume centers. Such information can be used to inform best practices and improve access to care.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

New York, N.Y.

From the Plastic and Reconstructive Surgical Service, Memorial Sloan-Kettering Cancer Center.

Received for publication October 2, 2012; accepted February 13, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. This work had no specific funding.

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Evan Matros, M.D., M.M.Sc.Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, MRI 1036, New York, N.Y. 10065, matrose@mskcc.org

©2013American Society of Plastic Surgeons