title: A nationwide analysis of the relationship between hospital volume and outcome for autologous breast reconstruction.
abstract: BACKGROUND
  The volume-outcome relationship has not been specifically measured for U.S. autologous breast reconstruction. The authors studied whether there is a relationship between hospital procedural volume and perioperative complication rates.
  
  
  METHODS
  The authors identified (1) patients who underwent total mastectomy with immediate autologous reconstruction from 1998 to 2010 and (2) a subset of microsurgical cases from 2008 to 2010. Hospitals were categorized into quartiles based on number of yearly procedures. Outcomes included surgery-specific and systemic complications. A multivariable model was used to analyze the volume-outcome relationship after adjusting for other variables.
  
  
  RESULTS
  Over the 13-year study period, 21,016 immediate autologous reconstructions were recorded. Surgery-specific and systemic complication rates were 13.0 and 7.5 percent, respectively. Ninety-two percent of centers perform a very low (fewer than nine cases per year) or low (nine to 20 cases per year) number of procedures. The highest-volume centers (>44 cases per year) are located in metropolitan areas. An inverse relationship between reconstructive volume and surgery-specific and systemic complications was identified (p<0.01). In the multivariable analysis, centers with very low, low, and medium case volumes were more likely to have surgery-specific complications than high-volume centers (p<0.01). Very-low-volume compared with high-volume centers were more likely to have systemic complications (p<0.01).
  
  
  CONCLUSIONS
  Higher volume autologous breast reconstruction centers have lower complication rates. The volume-outcome relationship is stronger for surgery-specific than for systemic complications. Geographic disparities are present in the distribution of high-volume centers. Such information can be used to inform best practices and improve access to care.
  
  
  METHODS
  Risk, III.
authors.affiliation: New York, N.Y. From the Plastic and Reconstructive Surgical Service, Memorial Sloan-Kettering Cancer Center.
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Albornoz
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.forename: Lauren
authors.initials: L
authors.lastname: Hishon
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McCarthy
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
authors.forename: Evan
authors.initials: E
authors.lastname: Matros
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000401:mortality* / Q000706:statistics & numerical data; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012086:Reoperation; D013524:Surgical Flaps / Q000098:blood supply*; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014481:United States; D016526:Workload / Q000706:statistics & numerical data*
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