Decreasing Time to Definitive Breast Reconstruction: National Trends and Patient-Level Predictors.

Abstract

The time interval between mastectomy and breast reconstruction reflects the speed of care delivery and has been associated with patient quality of life. This study evaluates 2010-2020 trends in the reconstructive interval and additional metrics of care delivery, including length-of-stay and outpatient setting utilization. A retrospective cohort study of 2010-2020 mastectomy patients was conducted using national insurance claims data. Trends in the reconstructive interval were analyzed for recipients of nonimmediate breast reconstructions via linear regression. Multivariable analysis was used to identify predictors of interval durations. Trends in inpatient length-of-stay and outpatient surgery utilization were assessed via linear regression for nonimmediate reconstructions, immediate reconstructions, and mastectomy-only surgeries. 350,243 patients (median age, 59.0) were included. From 2010 to 2020, the median reconstructive interval decreased from 187 to 168 days for nonimmediate implant reconstructions (β = - 1.92; p < 0.001) and from 337 to 288 days for nonimmediate autologous reconstructions (β = - 5.00; p = 0.002). Predictors of prolonged reconstructive intervals were interval radiation therapy (β = 130.87; p < 0.001), interval chemotherapy (β = 70.30; p < 0.001), autologous reconstruction technique (β = 38.33; p < 0.001), and Medicaid insurance (β = 28.84; p < 0.001). From 2010 to 2020, mean inpatient length-of-stay decreased for four of the six surgery types, including immediate implant reconstructions (2.00 to 1.65 nights; β = - 0.03; p = 0.009) and immediate autologous reconstructions (4.00 to 3.06 nights; β = - 0.08; p = 0.006). Outpatient utilization increased for all nonautologous surgeries, accounting for 82.2-98.0% of such cases in 2020. Nationally, decreasing reconstructive intervals coincided with decreasing inpatient length-of-stay and increasing outpatient surgery utilization. Collectively, these trends reflect a dramatic acceleration in breast reconstruction care delivery over the past decade.