A new study conducted by the Agency for Healthcare Research and Quality shows dramatic increases in outpatient complete mastectomies in five States. In Colorado, for instance, outpatient complete mastectomies jumped from under 1 percent in 1990 to 22 percent in 1996.
Claudia Steiner, M.D., M.P.H., of AHRQ's Center for Organization and Delivery Studies, and her colleagues Caroline Case, M.D., of Georgetown University, and Meg Johantgen, Ph.D., R.N., of the University of Maryland, reviewed hospital inpatient and outpatient discharge records for all women who were treated for cancer with a breast procedure, either lumpectomy, partial mastectomy, or complete mastectomy. Inpatient and outpatient surgery data were available between 1990 and 1996 in Colorado, Maryland, New Jersey, and New York and between 1993 and 1996 in Connecticut.
Dr. Steiner and her colleagues found that two key factors influence whether a woman gets a complete mastectomy in the hospital or in an outpatient setting: the State where she lives and who is paying for it. For example, women in New York were more than twice as likely, and in Colorado nearly nine times as likely, as women in New Jersey to have an outpatient complete mastectomy. Nearly all women who were Medicaid and Medicare beneficiaries were kept in the hospital after their surgery, as were 89 percent of women enrolled in HMOs.
Other significant findings include:
- Lumpectomies have been and continue to be performed almost exclusively in out-of-hospital settings.
- A woman's clinical characteristics—including severity of the breast cancer, presence of coexisting illness, extent of the surgery, and others—remain important considerations for an outpatient complete mastectomy.
- Women in this study were less likely to have complete mastectomies in outpatient settings if the procedure was performed at a publicly funded hospital or teaching hospital.
For more details, see "Outpatient mastectomy: Clinical, payer, and geographic influences," by Drs. Case, Johantgen, and Steiner, in the October 2001 Health Services Research 36(5), pp. 869-884.
Reprints (AHRQ Publication No. 01-R008) are available from the AHRQ Publications Clearinghouse.
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