Assessing the Quality of Microvascular Breast Reconstruction Performed in the Urban Safety-Net Setting – A Doubly Robust Regression Analysis

Background: Safety-Net Hospitals (SNH) serve vulnerable populations, however, care delivery may be of lower quality. Microvascular IBR, relative to other IBR subtypes, is sensitive to the performance of SNH with regards to clinical outcomes and an important quality marker. Our aim is to assess the quality of care associated with the SNH setting. Methods: The 2012-2014 National Inpatient Sample (NIS) was used to identify patients who underwent microvascular IBR after mastectomy. SNH were defined by the proportion of Medicaid patients. Primary outcomes of interest were rates of medical, surgical inpatient complications and prolonged length of stay (pLOS). A doubly-robust approach i.e. propensity score and multivariate regression, was used to analyze the impact of patient and hospital-level characteristics on outcomes. Results: A total of 858 patients comprised our analytic cohort following propensity matching. There were no significant differences in the odds of surgical and medical inpatient complications among SNH patients relative to their matched counterparts. Black (OR 2.95, p

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