Does patients' social deprivation influence access to outpatient surgery in breast cancer?

[OBJECTIVE] Outpatient surgery is currently considered as "best practice" for breast cancer surgery. To develop same-day outpatient surgery, France introduced a "single price" incentive that was applied to breast cancer surgery from 2014 on: hospital reimbursement was set at the same level for inpatient and outpatient surgery. The aim of our survey was to assess whether patient's social deprivation was associated with an impaired access to outpatient surgery (vs. inpatient surgery) for the treatment of a breast cancer.

[METHODS] We conducted a retrospective multicentre study on three hospitals in North-West France, using data from the hospital discharge databases. Based on the estimation of a multivariate binary logit model, we analysed factors associated with outpatient surgery (vs. inpatient surgery) in breast cancer patients, including social deprivation measured by the patient's European Deprivation Index (EDI) observed at a small area-level.

[RESULTS] We analysed 1859 hospitalisations. The most deprived patients (4th (Q4) and 5th (Q5) EDI quintiles) were less likely to have outpatient surgery, with absolute risk differences respectively equal to -0.08 (IC95% [-0.13; -0.03]) and -0.10 (IC95% [-0.16; -0.05]) compared to patients belonging to EDI Q1 (i.e. the least deprived).

[CONCLUSIONS] In our data, social deprivation was associated with a lower probability of outpatient surgery in breast cancer patients. As inpatient surgery is costlier for hospitals than outpatient surgery, the single price incentive is likely to penalize hospitals that admit more socially deprived patients and eventually induce hospitals to select patients.