The Impact of Breast Reduction Practice Variation in Hamilton, Ontario: A Cost Analysis
Bibliographic record
Abstract
Introduction: Bilateral breast reduction (BBR) is one of the most common Ministry of Health-funded plastic surgery procedures. Surgeon variation in BBR management has been reported. In this study, we aimed to answer the following: what are the current variations in plastic surgeons’ management of BBR in Hamilton, Ontario?, and what are the cost implications of these practice variations to the healthcare system and patients? Methods: An online survey was conducted to gather demographic and practice data from all plastic surgeons practicing in Hamilton from 2019 to 2024. Reference costs for pre-, intra-, and postoperative components of BBR were obtained from a tertiary academic care center, the Ontario Schedule of Benefits for Physician Services, and local nursing care agencies, and used in the calculation of individual surgeons’ healthcare and patient costs. Results: Among 17 plastic surgeons practicing in Hamilton, 9 perform BBR, and 7 participated in the survey (response rate = 77.8%). Variations in practice were identified across several areas, including drain use, nursing care, OR time, and frequency of physician appointments. The mean healthcare costs per BBR patient were $5156 and $7146 for the lowest- and highest-costing surgeons, respectively, resulting in a difference of up to $2034 per patient. Patient-borne costs varied from $92 to $179 between surgical practices. Conclusion: There is considerable variability in BBR practice among plastic surgeons in Hamilton, contributing to a difference in overall healthcare and patient costs. Given the importance of cost savings in a single-payer system, future research is warranted to standardize BBR practices.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".