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Detailed analysis of the impact of surgeon and hospital volume in microsurgical breast reconstruction
Author(s) -
Reid Chris M.,
Parmeshwar Nisha,
Brandel Michael G.,
Crisera Christopher A.,
Herrera Fernando A.,
Suliman Ahmed S.
Publication year - 2020
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.30591
Subject(s) - medicine , breast reconstruction , confidence interval , logistic regression , odds ratio , microsurgery , cluster analysis , odds , surgery , breast cancer , statistics , mathematics , cancer
Abstract Background Prior investigations of microsurgical breast reconstruction have not distinguished the effects of surgeon versus hospital volume and failed to address the effect of patient clustering. Our data‐driven analysis aims to determine the impacts of surgeon and hospital volume on outcomes of microsurgical breast reconstruction. Methods Nationwide Inpatient Sample (NIS) data from 2008 to 2011 was analyzed for patients who underwent microsurgical breast reconstruction. Volume‐outcome relationships were analyzed with restricted cubic spline analysis. A multivariable mixed‐effects logistic regression was used to account for patient clustering effect. Results A total of 5,404 NIS patients met inclusion criteria. High‐volume (HV) surgeons had a 59% decrease in the risk of inpatient complications, which became non‐significant after clustering correction. For HV hospitals, there was a 47% decrease in the risk of inpatient complications (odds ratio = 0.53; 95% confidence intervals 0.30, 0.91; p = 0.021) that was statistically significant with the clustering adjustment. Neither the volume‐cost relationship for surgeons nor hospitals remained statistically significant after accounting for clustering. Conclusions Hospital volume plays a significant impact on outcomes in microsurgical breast reconstruction, while surgeon volume has comparatively not shown to be similarly impactful. The complexity of care related to microsurgical breast reconstruction warrants equally complex and engineered health systems.