乳房切除术后的乳房重建在美国尚未得到充分利用。有证据表明，竞争更加激烈的医院市场提供了更多获得跨专业程序护理的机会。本研究旨在确定区域整形外科医生竞争对乳腺癌乳房切除术后乳房重建的使用、结果和成本的影响。我们使用 2009 年至 2020 年的 Marketscan 索赔数据进行了回顾性横断面分析。赫芬达尔-赫希曼指数（HHI）是市场集中度的衡量标准，是使用大都市统计区（MSA）中每位外科医生进行的乳房重建病例比例的平方和计算得出的。使用多变量逻辑回归来确定 HHI 重建率、结果和成本的差异。中等竞争性患者在乳房切除术后两年内接受乳房重建的几率较高（OR：1.51 [95% CI：1.37 至 1.66] ；p<0.001）或竞争性（OR：1.71 [95% CI：1.58 至 1.86]；p<0.001）= 区域与非竞争性区域相比。当比较中等竞争地区与非竞争地区时，患者自付费用下降（-$67.38，[95% CI：-$88.65 至 -$46.11]；p=0.007），当比较竞争地区与非竞争地区时，患者自付费用进一步下降（- 113.06 美元，[95% CI：-137.00 美元至 -89.12 美元]；p=0.02）。外科医生或设施总成本与市场竞争阶层之间没有发现线性关联。外科医生之间的更大竞争与重建手术机会的增加有关，但成本没有差异。该证据的应用可能包括加强护理协调的系统级策略，同时通过政策针对医院和医院系统等成本驱动因素。版权所有 © 2024，美国整形外科医生协会。

Breast reconstruction following mastectomy is underused in the United States. Evidence suggests that more competitive hospital markets offer increased access to procedural care across specialties. This study aims to determine the impact of regional plastic surgeon competition on use, outcomes, and cost of breast reconstruction following mastectomy for breast cancer.We conducted a retrospective cross-sectional analysis using Marketscan claims data from 2009 to 2020. The Herfindahl-Hirschman Index (HHI), a measure of market concentration, was calculated using the sum-of-squares of the proportion of breast reconstruction cases performed by each surgeon in a metropolitan statistical area (MSA). Multivariable logistic regression was used to identify differences in rates, outcomes, and costs of reconstruction by HHI.Odds of receiving breast reconstruction within two years of mastectomy were higher for those in moderately competitive (OR: 1.51 [95% CI: 1.37 to 1.66]; p<0.001) or competitive (OR: 1.71 [95% CI: 1.58 to 1.86]; p<0.001) = regions compared to noncompetitive regions. Patient out-of-pocket costs decreased when comparing moderately competitive regions to noncompetitive regions (-$67.38, [95% CI: -$88.65 to -$46.11]; p=0.007), and further decreased when comparing competitive to non-competitive regions (-$113.06, [95% CI: -$137.00 to -$89.12]; p=0.02). No linear association between total, surgeon, or facility cost and market competition strata was identified.Greater competition among surgeons is associated with improved access to reconstructive surgery, but no difference in cost. Application of this evidence may include system-level strategies to bolster care coordination, while targeting drivers of cost, such as hospitals and hospital systems, through policy.Copyright © 2024 by the American Society of Plastic Surgeons.