Correlates of referral practices of general surgeons to plastic surgeons for mastectomy reconstruction

  • Alderman A
  • Hawley S
  • Waljee J
 et al. 
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BACKGROUND: General surgeons' attitudes toward breast reconstruction may affect referrals to plastic surgeons. The propensity to refer to plastic surgeons prior to surgical treatment decisions for breast cancer varies markedly across general surgeons and is associated with receipt of reconstruction. In this study, the authors used data from a large physician survey to examine factors associated with general surgeons' propensity to refer breast cancer patients to plastic surgeons prior to mastectomy. METHODS: The authors surveyed all attending general surgeons (N=456 surgeons) from a population-based sample of breast cancer patients who were diagnosed in Detroit and Los Angeles during 2002 (N=1844 patients), with a surgeon response rate of 80%. The dependent variable was surgeon report of the percentage of their mastectomy patients in the past 2 years who they referred to plastic surgeons prior to initial surgery (referral propensity). Referral propensity was collapsed into 3 categories (75%) and regressed on the following covariates using logistic regression: Surveillance, Epidemiology, and End Results registry; number of years in clinical practice; surgeons' sex; annual breast surgery volume; and hospital setting. RESULTS: Only 24% of surgeons referred>75% of their patients to plastic surgeons prior to surgery (high referral propensity). High referral propensity was associated independently with surgeons who were women (odds ratio [OR], 2.3; P=.03), high clinical breast surgery volume (OR, 4.1; P

Author-supplied keywords

  • Breast reconstruction
  • End Results
  • Epidemiology
  • Practice patterns
  • Surgical decision-making
  • Surveillance

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  • Amy K. Alderman

  • Sarah T. Hawley

  • Jennifer Waljee

  • Monica Morrow

  • Steven J. Katz

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