Hospital Variations in Clinical Complications and Patient Reported Outcomes at Two Years Following Immediate Breast Reconstruction
Nicholas L. Berlin, MD, MPH1, Vickram J. Tandon, MD1, Ji Qi, MS1, Hyungjin M. Kim, ScD1, Jennifer B. Hamill, MPH1, Adeyiza O. Momoh, MD1, Andrea L. Pusic, MD, MHS2, Edwin G. Wilkins, MD, MS1.
1University of Michigan, Ann Arbor, MI, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Over the past few decades, variations in medical practice have been viewed as opportunities to promote best practices and high-value care. Our objectives were to investigate case-mix adjusted hospital variations in two-year clinical and patient-reported outcomes (PROs) following immediate breast reconstruction.
The Mastectomy Reconstruction Outcomes Consortium Study is an NCI-funded longitudinal, prospective cohort study assessing clinical and patient reported outcomes of immediate breast reconstruction following mastectomy at eleven leading medical centers. Case-mix adjusted comparisons were performed using generalized linear mixed-effects models to assess variation across the centers in any complication, major complications, satisfaction with outcome, and satisfaction with breast.
Among 2,252 women in the analytic cohort, 1,605 (71.3%) underwent implant-based and 647 (28.7%) underwent autologous breast reconstruction. There were differences in the sociodemographic and clinical characteristics, and distribution of procedure types. After case-mix adjustments, significant variations in the rates of any and major postoperative complications were observed. Medical center odds ratios for major complication ranged from 0.58 to 2.13, compared with the average rate across centers. There were also differences in satisfaction with outcome (from the lowest to highest of -2.79 to 2.62) and in satisfaction with breast (-2.82 to 2.07) compared with the average values.
Postoperative complications varied widely between hospitals following breast reconstruction. These variations represent an important opportunity to improve care through dissemination of best practices and participation in regional collaboratives. Our findings also emphasize the limitations of extrapolating single-institution level data and the need for additional multi-institutional studies for this population.
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