title: Pediatric reduction mammaplasty: A retrospective analysis of the Kids' Inpatient Database (KID).
abstract: OBJECTIVE
  Pediatric breast reduction mammaplasty is a procedure commonly performed in children suffering from excess breast tissue, back pain, and social anxiety. Minimal information exists regarding demographics, epidemiology, and complications in adolescents. As health care reform progresses, investigating the socioeconomic and patient-related factors affecting cost and operative outcomes is essential.
  
  
  METHODS
  The Kids' Inpatient Database (KID) was used from 2000 to 2009. Patients with an International Classification of Diseases, 9th Revision code of macromastia and procedure code of reduction mammaplasty 20 and less were included. Demographic data, including age, sex, payer mix, and location, were collected. Significant independent variables associated with complications and duration of stay were identified with bivariate and multiple regression analysis.
  
  
  RESULTS
  A total of 1,345 patients between the ages 12 and 20 were evaluated. The majority of patients were white (64%), from a zip code with greatest income (36%), and had private insurance (75%). Overall comorbidity and complication rates were 30% and 3.2%, respectively. Duration of stay was associated with race, income quartile, insurance type, having complications, and hospital type. African-American race, Medicaid, lower income, and private-investor owned hospitals were predictive of greater hospital charges.
  
  
  CONCLUSIONS
  In this large retrospective database analysis, pediatric reduction mammaplasty had a relatively low early complication rate and short duration of stay. Complications, total charges, and duration of stay discrepancies were associated with race, location, and socioeconomic status. Although demonstrably safe, this is the first study demonstrating the negative effect of race and socioeconomic status on a completely elective procedure involving children. These results demonstrate the intricate association between socioeconomic and patient-related factors influencing overall outcomes in the pediatric population.
authors.affiliation: Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Tahereh
authors.initials: T
authors.lastname: Soleimani
authors.affiliation: Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Tyler A
authors.initials: TA
authors.lastname: Evans
authors.affiliation: Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sood
authors.affiliation: Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Ivan
authors.initials: I
authors.lastname: Hadad
authors.affiliation: Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Juan
authors.initials: J
authors.lastname: Socas
authors.affiliation: Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Roberto L
authors.initials: RL
authors.lastname: Flores
authors.affiliation: Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN. Electronic address: stholpad@iupui.edu.
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Tholpady
mesh_terms: D000293:Adolescent; D001940:Breast / Q000002:abnormalities* / Q000601:surgery; D002648:Child; D016208:Databases, Factual; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D006984:Hypertrophy / Q000191:economics / Q000601:surgery*; D007902:Length of Stay / Q000191:economics; D016462:Mammaplasty / Q000191:economics; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult