title: The influence of sociodemographic factors and hospital characteristics on the method of breast reconstruction, including microsurgery: a U.S. population-based study.
abstract: BACKGROUND
  Microsurgical breast reconstruction has gained popularity because of associations with decreased abdominal morbidity and high satisfaction. Nationwide use of these procedures is unknown. Although many factors can influence the method of breast reconstruction, sociodemographic and hospital characteristics have not been specifically evaluated. The authors studied the importance of microsurgical flaps among the techniques available for breast reconstruction and evaluated the effect of sociodemographic and hospital characteristics on the technique chosen.
  
  
  METHODS
  A cross-sectional study of breast reconstructions was performed using the Nationwide Inpatient Sample database for 2008. National estimates of breast reconstructive procedures including microsurgery were obtained. Impact of variables on reconstructive method was analyzed using logistic regression.
  
  
  RESULTS
  Among women undergoing breast reconstruction in 2008, implants were the most common procedure (60.5 percent), followed by pedicled flaps (34 percent) and microsurgical flaps (5.5 percent). Multivariable analysis showed that women aged 50 to 59 years, treated at teaching hospitals, with private insurance, or undergoing delayed reconstruction were more likely to have autologous than implant reconstruction. Implant use was associated with young patients, Caucasians, Asians, higher income, and all regions except the Northeast. Analysis of autologous reconstructions showed the likelihood for a microsurgical versus a pedicle flap was greater in teaching hospitals, private insurance carriers, and delayed reconstructions.
  
  
  CONCLUSIONS
  Microsurgical techniques are currently used in only a minority of reconstructions. Sociodemographic variables and teaching hospital status influence the method of breast reconstruction. The presence of disparities in care suggests that current decision making for breast reconstruction is not based solely on patient preference or anatomical features.
authors.affiliation: New York, N.Y. From the Plastic and Reconstructive Surgical Service and the Center for Health Policy and Outcomes, Memorial Sloan-Kettering Cancer Center.
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Albornoz
authors.forename: Peter B
authors.initials: PB
authors.lastname: Bach
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McCarthy
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.forename: Evan
authors.initials: E
authors.lastname: Matros
mesh_terms: D000367:Age Factors; D001943:Breast Neoplasms / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods / Q000706:statistics & numerical data*; D008866:Microsurgery / Q000706:statistics & numerical data*; D008875:Middle Aged; D044469:Racial Groups; D012959:Socioeconomic Factors; D013524:Surgical Flaps; D014481:United States