The analyses show that state laws had a significant impact on only the likelihood of outpatient mastectomy, which was reduced by five percentage points.
The growing prevalence of outpatient breast cancer surgery, particularly outpatient mastectomy, attracted widespread public attention in 1997, when its potential dangers were mentioned in President Clinton's State of the Union Address (Clinton 1997).
Along with its growing prevalence, outpatient mastectomy has provoked controversy.
Figures 1 to 3 provide illustrative time trends for outpatient mastectomy in the intervention and comparison states.
These figures consistently suggest that the laws may be associated with a lower likelihood of outpatient mastectomy, particularly in the first 12 months after adoption of the laws.
The impact of the laws on outpatient mastectomy, however, became less apparent in the period 13 to 36 months post adoption of the laws.
Population-based reporting on outpatient mastectomy is limited to one study using Medicare data, which demonstrated no significant differences in complications, readmissions, and mortality when compared to inpatient mastectomy (Warren, Riley, Potosky, et al.
Multivariate logistic regression analyses were conducted to determine whether HMO payer and state affected the likelihood of undergoing an outpatient mastectomy. All complete mastectomy observations from the five states for 1996 were combined, and dummy variables for state were assigned.
Compared to women who received complete mastectomies in New Jersey, women in Colorado were 8.6 times more likely to receive an outpatient mastectomy, 4.7 times more like in Maryland, 2.6 times more likely in Connecticut, and 1.3 times more likely in New York (Table 2).
Although premenopausal age demonstrated no difference, the adjusted likelihood of receiving an outpatient mastectomy was significantly lower if a women had any comorbidities, metastases, or evidence of reconstruction (OR = 0.23, 0.44, and 0.13, respectively) and significantly higher if she received a simple rather than a more extensive mastectomy (OR = 3.13).
The likelihood of receiving an outpatient mastectomy was 60 percent lower in a publicly funded hospital but was no different in private nonprofit compared to for-profit hospitals or urban compared to nonurban hospitals.