PRS Journal Club “Legislative Impact on Reconstruction Rates” with Evan Matros, MD - May 2025 Journal Club
May 14, 2025
Evan Matros, MD, a leading surgeon and program director at Memorial Sloan Kettering Cancer Center, explores the intricate relationship between legislation and breast reconstruction rates. He discusses significant disparities among racial and ethnic groups, despite improvements post-Affordable Care Act. Dr. Matros emphasizes the role of financial barriers and social determinants in accessing care, urging a deeper examination of healthcare inequities. He calls for research and targeted interventions to ensure all patients can benefit from reconstruction options.
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Persistent Disparities Despite Overall Rise
- Reconstruction rates rose for all groups from 2005–2022 according to NISQIP.
- Yet American Indian, Asian, and Black patients still had lower post-ACA reconstruction rates than White patients.
Limits Of NISQIP For Linking Care
- NISQIP lacks patient identifiers and granular variables like insurance and geography.
- That limits ability to link mastectomy to subsequent reconstruction and analyze drivers of disparity.
Leverage Natural Experiments Analytically
- Use a difference-in-differences design leveraging state Medicaid expansion as a natural experiment.
- Compare reconstruction rate slopes in expansion versus non-expansion states to isolate ACA effects.