D. E. Brown2, E. Bakillah1, C. Rosen1, J. Sharpe1, L. C. Elmore1, R. Kelz1 1Hospital Of The University Of Pennsylvania, Philadelphia, PA, USA 2Perelman School of Medicine, University Of Pennsylvania, Philadelphia, PA, USA
Introduction: Serious mental illness (SMI) is associated with decreased odds of guideline-concordant breast cancer treatment, including surgery. There is limited data on the impact of SMI on receipt of post-mastectomy breast reconstruction. We aimed to evaluate receipt of post-mastectomy reconstruction for patients with SMI compared to those without SMI and to assess patient factors that influence probability of reconstruction.
Methods: We performed a retrospective cohort study of adults aged ≥18 years who received a mastectomy with a primary diagnosis of breast cancer using the Healthcare Cost and Utilization Project State Inpatient Database and State Ambulatory Surgery and Services Database in FL, MD, VT, UT, and WI (2016-2020), excluding patients with secondary malignant neoplasms to the breast or skin. SMI was defined using ICD-10 codes for schizophrenia spectrum, mood, or anxiety disorders. The primary outcome was receipt of breast reconstruction, which included both immediate and delayed reconstruction. Secondary outcomes included type of reconstruction (implant vs. autologous) and reconstruction setting (inpatient vs. outpatient). The conditional effects of race, insurance status, and home-to-hospital travel distance on outcomes were evaluated. Multivariable logistic regression was used to examine predicted probability of outcomes with adjustment for potential confounders.
Results: Among 53,394 patients who received mastectomy for breast cancer, 23,839 (44.6%) received one or more reconstructive procedures. 21,765 (91.3%) received an implant approach and 3,104 (13.0%) an autologous approach. Overall, 8,915 (16.7%) had SMI. Patients with SMI were more likely to be white (78% vs. 68%, p<0.001) with more comorbidities (3 vs. 1, p<0.001), lower rates of private insurance (46% vs. 50%, p<0.001) and closer home-to-hospital distance (median 8.8 vs. 9.1 miles, p<0.001) than patients without SMI. After adjustment for potential confounders, patients with SMI had a higher probability of receiving any reconstruction and inpatient reconstruction than patients without SMI, but similar probability of implant or autologous approach (Table). Private insurance, race, and longer travel distance (≥ median 9.1 miles) were associated with larger differential impact of SMI on the probability to receive reconstruction (Table).
Conclusion: Patients with SMI had higher probability of receiving reconstruction overall and in the inpatient setting, with private insurance, race, and longer travel distance increasing that effect. These findings are reassuring about access to post-mastectomy reconstruction for patients with SMI and suggest appropriate identification of inpatient needs for this population when receiving reconstruction.
