Steep Rise Largely Seen in Older Women, Outpatient Procedures
The portion of women who elected to have breast reconstruction surgery after a mastectomy increased 65 percent between 2009 and 2014, with the sharpest rise occurring among women aged 65 and older, according to a new analysis by the Agency for Healthcare Research and Quality (AHRQ).
Much of the increase was attributable to a 150 percent increase in reconstruction surgeries performed in hospital-based ambulatory surgery centers. Breast reconstructions in those outpatient settings increased from 7 per 100,000 women in 2009 to 18 per 100,000 in 2014. The rate remained unchanged — 7 per 100,000 — for inpatient reconstructions during the same period.
AHRQ’s analysis provides new insights into the complex and emotional decisions made by women following mastectomies. This type of information is essential for policymakers and health systems seeking to keep pace with important trends in clinical care.
Although rates for reconstruction surgery increased for women in all insurance categories between 2009 to 2014, AHRQ’s analysis showed the steepest increase — 130 percent — occurred among Medicare patients.
The gap between insured and uninsured women has narrowed, as the rate of reconstructive surgery increased faster for uninsured women (104 percent) than for privately insured women (51 percent). In 2014, for every 100 uninsured women who underwent a mastectomy, 44 had reconstructive surgery. The number for privately insured women was 52.
"This information suggests that many uninsured women were willing to pay for reconstruction surgery out of pocket," said Anne Elixhauser, Ph.D., senior scientist at AHRQ.
AHRQ’s report on both inpatient and outpatient reconstruction surgeries draws on data from 22 states, which represents 59 percent of the U.S. population. Additional findings include:
- While the overall rate of women undergoing mastectomies declined slightly between 2009 and 2014, the rate of those who chose reconstruction surgeries increased from about 24 per 100 mastectomies to 40 per 100 during that period.
- Reconstruction surgeries among women 65 and older rose 140 percent between 2009 and 2014, the largest increase of any age group, though the rate of reconstruction was the lowest for Medicare compared to all other payers — 19 reconstructions for every 100 mastectomies.
- In 2014, reconstruction surgeries occurred less often among women in rural areas (29 per 100 mastectomies) than those in urban areas (41 per 100).
- Black women were more likely to receive breast reconstruction surgery in an inpatient setting, compared with white and Hispanic women.