T. A. Evans1, T. Soleimani1, R. Sood1, I. Hadad1, J. Socas1, R. L. Flores1, S. S. Tholpady1 1Indiana University School Of Medicine,Division Of Plastic Surgery,Indianapolis, IN, USA
Introduction: Pediatric breast reduction mammaplasty is a commonly performed procedure in children with excess breast tissue, back pain, and social anxiety. Although technical aspects of the procedure are no different between adults and children, minimal information exists regarding patient-related factors influencing outcomes in adolescents. As healthcare reform progresses, it is essential to investigate the socioeconomic factors that affect surgical outcomes. This study was designed to explore the socioeconomic and geographic disparities and their effects on hospital length of stay.
Methods: The Kids Inpatient Database (KID) was utilized from years 2000-2009. All patients with an ICD-9 diagnosis code of macromastia and procedure code of reduction mammaplasty 20 and under were included. Demographic data including age, sex, race, payer mix, location of operation, and ZIPINC-quartile were collected. Significant independent variables associated with complications and length of stay were generated using multivariate analysis.
Results: A total of 1345 patients between the ages of 12 to 20 were evaluated. The majority of the patients were white (64.04%), from a zip-code with highest (fourth quartile) income (35.93%), and having private insurance as their primary payer (75.4%). Most of the surgeries were performed in large (58.08%), teaching (65.04%), private-not for profit (84.71%) hospitals located in urban areas. The most frequent region reductions were performed was the Northeast (37.11%). Overall comorbidity and complication rates were 30% and 1.64%, respectively. Hemorrhage/hematoma/seroma and having at least one complication were both associated with having other procedures and with the region of hospital. Mean length of stay (LOS) was 1.1 days. African-American race, Medicaid/government payer source, low income, having comcominant procedures/complications and Southern hospitals were significantly associated with increased LOS.
Conclusion: The results of this large retrospective database analysis show that breast reduction surgery in the adolescent population has a comparatively low early complication rate and short length of hospital stay. Socioeconomic and geographic disparities are associated with longer length of stay following pediatric reduction mammaplasty. Factors causing these demographic and patient-related discrepancies should be furthered assessed to improve surgical outcomes in this population.
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