Effect of hospital teaching status on in-hospital outcomes of autologous and implant-based breast reconstruction

Hospital’s teaching status has been shown to impact surgical outcomes. However, the impact of hospital teaching status on breast reconstruction outcomes remains unexplored. Therefore, this study aimed to compare in-hospital outcomes for patients who stayed in teaching hospitals (TH) vs. non-TH for autologous (ABR) and implant-based breast reconstruction (IBBR) in a population-based analysis.

National Inpatient Sample (NIS) was used to identify patients who went under ABR or IBBR from Q4 2015–2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients who stayed in TH and non-TH for ABR and IBBR, respectively. Demographics, primary payer status, hospital characteristics, and comorbidities were adjusted.

There were 11,584 and 1,345 patients undergoing ABR in TH and non-TH, respectively. Meanwhile, there were 14,637 and 3,059 patients underwent IBBR in TH and non-TH, respectively. In both ABR and IBBR, patients treated in THs tended to be younger, more socioeconomically disadvantaged, and had higher comorbidity burdens. In ABR, patients in TH had higher renal complications (aOR = 3.1, 95 CI = 1.109–8.666, p = 0.03) but lower wound dehiscence (aOR = 0.531, 95 CI = 0.317–0.889, p = 0.02) and transferring out (aOR = 1.61, 95 CI = 1.322–1.961, p < 0.01). In IBBR, Patients in TH had higher capsular contracture (aOR = 1.526, 95 CI = 1.108–2.101, p = 0.01), superficial wound complications (aOR = 1.383, 95 CI = 1.075–1.778, p = 0.01), and seroma (aOR = 1.805, 95 CI = 1.118–2.914, p = 0.02). In both ABR and IBBR, patients in TH had less total hospital charge (p < 0.01).

Hospital teaching status impacts breast reconstruction outcomes, especially in IBBR. These disparities may be attributable to several factors including limited healthcare access among disadvantaged patients, tendency of THs to receive referrals for more complex cases, involvement of trainees in THs, and challenges in resource allocation for specialized staff in THs. While the underlying causes of these disparities warrant further investigation, ensuring equitable access to healthcare and the quality of healthcare delivery in both THs and non-THs is crucial.

Level III, Risk/Prognostic; Therapeutic