A nationwide analysis of the relationship between hospital volume and outcome for autologous breast reconstruction Journal Article
| Authors: | Albornoz, C. R.; Cordeiro, P. G.; Hishon, L.; Mehrara, B. J.; Pusic, A. L.; McCarthy, C. M.; Disa, J. J.; Matros, E. |
| Article Title: | A nationwide analysis of the relationship between hospital volume and outcome for autologous breast reconstruction |
| Abstract: | 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. © 2013 by the American Society of Plastic Surgeons. |
| Journal Title: | Plastic and Reconstructive Surgery |
| Volume: | 132 |
| Issue: | 2 |
| ISSN: | 0032-1052 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2013-08-01 |
| Start Page: | 192e |
| End Page: | 200e |
| Language: | English |
| DOI: | 10.1097/PRS.0b013e31829586c1 |
| PROVIDER: | scopus |
| PUBMED: | 23897346 |
| DOI/URL: | |
| Notes: | "Export Date: 4 September 2013" - "CODEN: PRSUA" - "Source: Scopus" |
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