Impact of Safety-Net Hospital Status on Immediate Reconstruction Following Mastectomy: A Contemporary National Analysis

Introduction Immediate breast reconstruction (IBR) following mastectomy has been shown to improve quality of life and partially mitigate the adverse psychological impacts associated with the procedure. The present study examined hospital-based and patient-level disparities in utilization and outcomes of IBR following mastectomy. Methods All female adult hospitalizations with a diagnosis of breast cancer undergoing mastectomy were identified in the 2016 to 2020 National Inpatient Sample. Safety-net hospitals (SNH) were defined as those in the top quartile of all Medicaid or self-pay admissions. Patients who underwent mastectomy at SNH comprised the SNH cohort (others: Non-SNH). Multivariable models were developed to examine the impact of SNH status and patient factors on rates of IBR. Results Of an estimated 127,740 hospitalizations, 28,330 (22.2%) were treated at SNH. The proportion of patients receiving IBR increased from 46.7% in 2016 to 51.7% in 2020 (nptrend