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J Reconstr Microsurg 2020; 36(08): 592-599
DOI: 10.1055/s-0040-1713174
Original Article

Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP

Louise L. Blankensteijn
1   Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Sebastian Sparenberg
1   Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Dustin T. Crystal
1   Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Ahmed M.S. Ibrahim
1   Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Bernard T. Lee
1   Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Samuel J. Lin
1   Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
› Author Affiliations Funding None.
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Abstract

Background In various surgical specialties, racial disparities in postoperative complications are widely reported. It is assumed that the effect of race can also be found in plastic surgical outcomes, although this remains largely undefined in literature. This study aims to provide data on the impact of race on outcomes of reconstructive breast surgery.

Methods Data were collected using the NSQIP (National Surgical Quality Improvement Program) database (2008–2016). Outcomes of the reconstructive breast surgery of White patients were compared with those of African American, Asian, or other races. Logistic regression was performed to control for variations between all groups. Analysis of racial disparities was further sub-stratified according to four different types of breast reconstruction: delayed or immediate autologous, and delayed or immediate prosthesis-based reconstruction.

Results In total, this study included 51,362 patients of which 43,864 were Caucasian, 5,135 African American, 2,057 Asian, and 332 of other races. When compared with White patients, patients of African American race had larger body mass indices (31.3 ± 7.0 vs. 27.6 ± 6.3, p-value < 0.001) in addition to higher rates of diabetes (12.3 vs 4.6%, p-value < 0.001) and hypertension (44.7 vs. 23.4%, p-value < 0.001). Both multivariate analysis and the sub-stratified analysis of different types of reconstruction showed no differences in overall complication rate.

Conclusion Among the four types of reconstructive procedures, differences in surgical outcomes do not appear to be based on race and therefore seem to be less evident in reconstructive breast surgery compared with the current literature within other surgical specialties.

Keywords

reconstruction - breast reconstruction - race - minority - racial disparities - NSQIP

Ethical Approval

The patient information in this study is deidentified and available to all institutions complying with ACS NSQIP data use agreement.


Note

The ACS NSQIP databases are the source of information used in this study. Data extrapolated, statistical analysis performed, and conclusions reach have not been verified by the ACS-NSQIP but rather are the result of the work done by authors of this study.


Supplementary Material



Publication History

Received: 15 January 2020

Accepted: 05 May 2020

Article published online:
18 June 2020

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Bloo GJA, Hesselink GJ, Oron A. , et al. Meta-analysis of operative mortality and complications in patients from minority ethnic groups. Br J Surg 2014; 101 (11) 1341-1349
    CrossrefPubMedGoogle Scholar
  • 2 Skolasky RL, Thorpe Jr RJ, Wegener ST, Riley III LH. Complications and mortality in cervical spine surgery: racial differences. Spine 2014; 39 (18) 1506-1512
    CrossrefPubMedGoogle Scholar
  • 3 Hauch A, Al-Qurayshi Z, Friedlander P, Kandil E. Association of socioeconomic status, race, and ethnicity with outcomes of patients undergoing thyroid surgery. JAMA Otolaryngol Head Neck Surg 2014; 140 (12) 1173-1183
    CrossrefPubMedGoogle Scholar
  • 4 Williams DR, Priest N, Anderson NB. Understanding associations among race, socioeconomic status, and health: patterns and prospects. Health Psychol 2016; 35 (04) 407-411
    CrossrefPubMedGoogle Scholar
  • 5 Haider AH, Scott VK, Rehman KA. , et al. Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors. J Am Coll Surg 2013; 216 (03) 482-92.e12
    CrossrefPubMedGoogle Scholar
  • 6 Lucas FL, Stukel TA, Morris AM, Siewers AE, Birkmeyer JD. Race and surgical mortality in the United States. Ann Surg 2006; 243 (02) 281-286
    CrossrefPubMedGoogle Scholar
  • 7 Soni SE, Lee MC, Gwede CK. Disparities in use and access to postmastectomy breast reconstruction among African American women: a targeted review of the literature. Cancer Contr 2017; 24 (04) 1073274817729053
    PubMedGoogle Scholar
  • 8 Shippee TP, Kozhimannil KB, Rowan K, Virnig BA. Health insurance coverage and racial disparities in breast reconstruction after mastectomy. Womens Health Issues 2014; 24 (03) e261-e269
    CrossrefPubMedGoogle Scholar
  • 9 Butler PD, Nelson JA, Fischer JP. , et al. Racial and age disparities persist in immediate breast reconstruction: an updated analysis of 48,564 patients from the 2005 to 2011 American College of Surgeons National Surgery Quality Improvement Program data sets. Am J Surg 2016; 212 (01) 96-101
    CrossrefPubMedGoogle Scholar
  • 10 Morrow M, Mujahid M, Lantz PM. , et al. Correlates of breast reconstruction: results from a population-based study. Cancer 2005; 104 (11) 2340-2346
    CrossrefPubMedGoogle Scholar
  • 11 Kamali P, Curiel D, van Veldhuisen CL. , et al. Trends in immediate breast reconstruction and early complication rates among older women: a big data analysis. J Surg Oncol 2017; 115 (07) 870-877
    CrossrefPubMedGoogle Scholar
  • 12 U.S. Congress. Breast cancer patient education act of 2015. Available at: https://www.congress.gov/bill/114th-con-gress/senate-bill/1192/text (PMID: . Accessed February 3, 2016)
    PubMedGoogle Scholar
  • 13 Du XL, Fang S, Meyer TE. Impact of treatment and socioeconomic status on racial disparities in survival among older women with breast cancer. Am J Clin Oncol 2008; 31 (02) 125-132
    CrossrefPubMedGoogle Scholar
  • 14 Chlebowski RT, Chen Z, Anderson GL. , et al. Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst 2005; 97 (06) 439-448
    CrossrefPubMedGoogle Scholar
  • 15 Butler PD, Nelson JA, Fischer JP. , et al. African-American women have equivalent outcomes following autologous free flap breast reconstruction despite greater preoperative risk factors. Am J Surg 2015; 209 (04) 589-596
    CrossrefPubMedGoogle Scholar
  • 16 Wu C, Clayton JL, Halvorson EG. Racial differences in ischemic complications of pedicled versus free abdominal flaps for breast reconstruction. Ann Plast Surg 2014; 72 (06) S172-S175
    CrossrefPubMedGoogle Scholar
  • 17 Body mass index. 2018 . Available at: http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi (PMID: . Accessed September 4, 2018)
    PubMedGoogle Scholar
  • 18 Plastic surgery statistics. American Society of Plastic Surgeons. . Available at: https://www.plasticsurgery.org/news/plastic-surgery-statistics (PMID: . Accessed September 4, 2018)
    PubMedGoogle Scholar
  • 19 Hardy KL, Davis KE, Constantine RS. , et al. The impact of operative time on complications after plastic surgery: a multivariate regression analysis of 1753 cases. Aesthet Surg J 2014; 34 (04) 614-622
    CrossrefPubMedGoogle Scholar
  • 20 Kwok AC, Edwards K, Donato DP. , et al. Operative time and flap failure in unilateral and bilateral free flap breast reconstruction. J Reconstr Microsurg 2018; 34 (06) 428-435
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Qiu CS, Jordan SW, Dorfman RG, Vu MM, Alghoul MS, Kim JYS. Surgical duration impacts venous thromboembolism risk in microsurgical breast reconstruction. J Reconstr Microsurg 2018; 34 (01) 47-58
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Berlin NL, Momoh AO, Qi J. , et al. Racial and ethnic variations in one-year clinical and patient-reported outcomes following breast reconstruction. Am J Surg 2017; 214 (02) 312-317
    CrossrefPubMedGoogle Scholar
  • 23 Noonan AS, Velasco-Mondragon HE, Wagner FA. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev 2016; 37: 12
    CrossrefPubMedGoogle Scholar
  • 24 Alderman AK, McMahon Jr L, Wilkins EG. The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors. Plast Reconstr Surg 2003; 111 (02) 695-703 , discussion 704–705
    CrossrefPubMedGoogle Scholar
  • 25 Sharma K, Grant D, Parikh R, Myckatyn T. Race and breast cancer reconstruction: is there a health care disparity?. Plast Reconstr Surg 2016; 138 (02) 354-361
    CrossrefPubMedGoogle Scholar
  • 26 Grabe S, Hyde JS. Ethnicity and body dissatisfaction among women in the United States: a meta-analysis. Psychol Bull 2006; 132 (04) 622-640
    CrossrefPubMedGoogle Scholar
  • 27 Li CI, Malone KE, Daling JR. Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 2003; 163 (01) 49-56
    CrossrefPubMedGoogle Scholar
  • 28 Parsons HM, Henderson WG, Ziegenfuss JY, Davern M, Al-Refaie WB. Missing data and interpretation of cancer surgery outcomes at the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2011; 213 (03) 379-391
    CrossrefPubMedGoogle Scholar
  • 29 Hamilton BH, Ko CY, Richards K, Hall BL. Missing data in the American College of Surgeons National Surgical Quality Improvement Program are not missing at random: implications and potential impact on quality assessments. J Am Coll Surg 2010; 210 (02) 125-139.e2
    CrossrefPubMedGoogle Scholar
  • 30 Holoyda KA, Simpson AM, Ye X, Agarwal JP, Kwok AC. Immediate bilateral breast reconstruction using abdominally based flaps: an analysis of the nationwide inpatient sample database. J Reconstr Microsurg 2019; 35 (08) 594-601
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Orr JP, Shammas RL, Thomas AB. , et al. Bleeding after free flap-based breast reconstruction: a NSQIP analysis. J Reconstr Microsurg 2019; 35 (06) 417-424
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Magno-Padron DA, Collier W, Kim J, Agarwal JP, Kwok AC. A nationwide analysis of early and late readmissions following free tissue transfer for breast reconstruction. J Reconstr Microsurg 2020
    PubMedGoogle Scholar
  • 33 Kwok AC, Simpson AM, Ye X, Tatro E, Agarwal JP. Immediate unilateral breast reconstruction using abdominally based flaps: analysis of 3,310 cases. J Reconstr Microsurg 2019; 35 (01) 74-82
    Article in Thieme ConnectPubMedGoogle Scholar