Impact of the National Accreditation Program for Breast Centers reconstruction standard on reconstruction rates at Commission on Cancer centers with breast center accreditation

Background: The objective of this study was to examine the impact of the National Accreditation Program for Breast Centers (NAPBC) breast center accreditation on breast reconstruction rates at Commission on Cancer (CoC) centers with (CoC-NAPBC) and without NAPBC accreditation (CoC-noNAPBC). Methods: We conducted a retrospective observational cohort study that queried the National Cancer Data Base (NCDB) for trends in breast reconstruction from 2009 to 2017. Multivariable logistic regression was used to determine if NAPBC accreditation was an independent predictor of receipt of reconstruction at CoC-NAPBC sites. Results: Of 172,865 patients treated with mastectomy at 451 CoC-NAPBC centers, 88,436 (51.2%) had reconstruction compared to 191,295 (33.7%) at CoC-noNAPBC sites. After adjusting for confounders, CoC-NAPBC centers were 32% more likely {odds ratio (OR) 1.32 [95% confidence interval (CI): 1.30-1.34]} to perform reconstruction than CoC-noNAPBC sites. The absolute difference in the proportion of CoCNAPBC sites that performed reconstruction before and after NAPBC accreditation went from 14.1% for centers accredited in 2010 to 2.9% for centers accredited in 2015. Comparing CoC-NAPBC to CoCnoNAPBC centers, more Black (38.5% vs. 24.8%), Hispanic (43.1% vs. 31.3%) and Asian Americans (35.5% vs. 26.7%) and Medicaid patients (35.6% vs. 22.5%) underwent reconstruction. Conclusions: NAPBC accreditation at CoC sites was associated with increased rates of reconstruction but this effect decreased by 2015. CoC-NAPBC sites have higher breast reconstruction rates than CoCnoNAPBC sites with fewer disparities by race, insurance status, and facility type.