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Health care utilization among women who have undergone breast implant surgery Spigelman, S. Aleina


Background: Women have long used breast implants to enhance their bust-lines or replace what was stolen by cancer or disease. This study, rather than investigating health outcomes, focuses on the issue of health care utilization and tests the hypothesis that receiving breast implants results in increased use of the public health system. Methods: Data were collected for a study cohort of 147 women who have undergone breast implant surgery and a non-implant comparison group of 583 women matched by birth cohort and geographic region. The data were extracted from the B.C. linked datasets. Outcome variables such as doctor's visits, specialist visits, number of hospitalizations, level of care in hospital and days of care in hospital were examined over the 11-year period from 1988/89 to 1998/99. Wilcoxon rank sum tests, chi-square tests and odds ratios were performed to analyze these data. Data were also collected from questionnaires completed by the women in the study group. These questionnaires collected additional implant information (e.g., type of implant, length of implantation) and lifestyle information (e.g., smoking, alcoholic drinks, exercise, marital status, number of children). Results: Statistical analyses showed that women who have or have had breast implants did experience more hospitalizations and did visit doctors and specialists significantly more than women who had not undergone implantation surgery. Women with implants were more likely to be admitted to hospital (OR = 4.26, 95% CI = 2.58, 7.02). They were more likely to be admitted electively (OR = 1.90, 95% CI = 1.50, 2.39) and less likely to be admitted as an urgent case (OR = 0.60, 95% CI = 0.46, 0.78) or emergency case (OR = 0.53, 95% CI = 0.35, 0.79). Survey information showed that, despite some limited relationships, neither lifestyle nor implant factors accounted for the increased health care utilization. Length of implantation resulted in decreased hospitali2ations, indicating a greater need for short-term hospital care, such as that associated with local breast-implant complications. Conclusion: Breast implant surgery does result in increased use of the public health care system. Further investigation is needed to determine the causal mechanism.

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