Number of Outpatient Lumpectomies and Mastectomies Soared in 1990s

The percentage of women undergoing lumpectomies or mastectomies on an outpatient basis increased dramatically between 1990 and 1996, particularly in several states, according to researchers at the Agency for Healthcare Research and Quality in Rockville, Maryland.

In their study published in Health Services Research, investigators report that by 1996, 78 to 88 percent of women undergoing lumpectomy were outpatients.

The incidence of subtotal mastectomies done on an outpatient basis increased from a range of 10 to 50 percent in 1990 to 43 to 72 percent in 1996, depending on the state where the surgery was performed.

The increase was more dramatic in some states such as Colorado where the percentage of outpatient subtotal mastectomies increased from 10 percent in 1990 to 67 percent in 1996.

The rate of outpatient total mastectomy was virtually zero in 1990 in all states, but by 1996 had increased to 3 percent in New Jersey, 4 percent in New York, 8 percent in Connecticut, 12 percent in Maryland and 22 percent in Colorado.

"While clinical factors remain important, the state in which a women undergoes a complete mastectomy and her primary payer greatly influence the choice of outpatient location for a complete mastectomy," said Dr. Claudia Steiner, senior author of the study.

Researchers reviewed hospital discharge records for all women treated with surgery for cancer in states and years that inpatient and outpatient surgery data was kept, including 1990 through 1996 in Colorado, Maryland, New Jersey, and New York and between 1993 and 1996 in Connecticut.

Surgical procedures included lumpectomy, subtotal mastectomy and complete mastectomy. Researchers also looked geographic location, influence of severity of illness, insurance coverage, and the extent of procedure and hospital characteristics on the decision to treat the surgeries as outpatient or inpatient procedures.

Insurance coverage was a key factor in whether or not a complete mastectomy included a hospital stay. Ninety-seven percent of Medicaid patients and 94 percent of Medicare patients stayed in the hospital compared to 89 percent of HMO patients.

Women were more likely to stay in the hospital if they were seriously ill, had other illnesses, needed breast reconstruction or had cancer that had spread. Women were also less likely to have outpatient surgery at a publicly funded or teaching facility.

"Decreases in the length of stay have rekindled concerns that the gains in health care savings may be at the expense of health care quality," said Steiner. "Quality must continue to be monitored."

Other Sources: Agency for Healthcare Research and Quality