title: A Multi-institutional Analysis of Insurance Status as a Predictor of Morbidity Following Breast Reconstruction.
abstract: BACKGROUND
  Although recent literature suggests that patients with Medicaid and Medicare are more likely than those with private insurance to experience complications following a variety of procedures, there has been limited evaluation of insurance-based disparities in reconstructive surgery outcomes. Using a large, multi-institutional database, we sought to evaluate the potential impact of insurance status on complications following breast reconstruction.
  
  
  METHODS
  We identified all breast reconstructive cases in the 2008 to 2011 Tracking Operations and Outcomes for Plastic Surgeons clinical registry. Propensity scores were calculated for each case, and insurance cohorts were matched with regard to demographic and clinical characteristics. Outcomes of interest included 15 medical and 13 surgical complications.
  
  
  RESULTS
  Propensity-score matching yielded 493 matched patients for evaluation of Medicaid and 670 matched patients for evaluation of Medicare. Overall complication rates did not significantly differ between patients with Medicaid or Medicare and those with private insurance (P = 0.167 and P = 0.861, respectively). Risk-adjusted multivariate regressions corroborated this finding, demonstrating that Medicaid and Medicare insurance status does not independently predict surgical site infection, seroma, hematoma, explantation, or wound dehiscence (all P > 0.05). Medicaid insurance status significantly predicted flap failure (odds ratio = 3.315, P = 0.027).
  
  
  CONCLUSIONS
  This study is the first to investigate the differential effects of payer status on outcomes following breast reconstruction. Our results suggest that Medicaid and Medicare insurance status does not independently predict increased overall complication rates following breast reconstruction. This finding underscores the commitment of the plastic surgery community to providing consistent care for patients, irrespective of insurance status.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, Pa.; American Society of Plastic Surgeons, Chicago, Ill.; and Department of Plastic Surgery, The Ohio State University, Columbus, Ohio.
authors.forename: Brittany L
authors.initials: BL
authors.lastname: Vieira
authors.affiliation: Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, Pa.; American Society of Plastic Surgeons, Chicago, Ill.; and Department of Plastic Surgery, The Ohio State University, Columbus, Ohio.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Lanier
authors.affiliation: Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, Pa.; American Society of Plastic Surgeons, Chicago, Ill.; and Department of Plastic Surgery, The Ohio State University, Columbus, Ohio.
authors.forename: Alexei S
authors.initials: AS
authors.lastname: Mlodinow
authors.affiliation: Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, Pa.; American Society of Plastic Surgeons, Chicago, Ill.; and Department of Plastic Surgery, The Ohio State University, Columbus, Ohio.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Bethke
authors.affiliation: Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, Pa.; American Society of Plastic Surgeons, Chicago, Ill.; and Department of Plastic Surgery, The Ohio State University, Columbus, Ohio.
authors.forename: Robert X
authors.initials: RX
authors.lastname: Murphy
authors.affiliation: Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, Pa.; American Society of Plastic Surgeons, Chicago, Ill.; and Department of Plastic Surgery, The Ohio State University, Columbus, Ohio.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Hume
authors.affiliation: Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, Pa.; American Society of Plastic Surgeons, Chicago, Ill.; and Department of Plastic Surgery, The Ohio State University, Columbus, Ohio.
authors.forename: Karol A
authors.initials: KA
authors.lastname: Gutowski
authors.affiliation: Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, Pa.; American Society of Plastic Surgeons, Chicago, Ill.; and Department of Plastic Surgery, The Ohio State University, Columbus, Ohio.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Fine
authors.affiliation: Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, Pa.; American Society of Plastic Surgeons, Chicago, Ill.; and Department of Plastic Surgery, The Ohio State University, Columbus, Ohio.
authors.forename: John Y S
authors.initials: JY
authors.lastname: Kim