RSS-Feed abonnieren
DOI: 10.1055/s-0040-1713174
Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP
Funding None.![](https://www.thieme-connect.de/media/jrm/202008/lookinside/thumbnails/10-1055-s-0040-1713174_190274-1.jpg)
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.
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.
Publikationsverlauf
Eingereicht: 15. Januar 2020
Angenommen: 05. Mai 2020
Artikel online veröffentlicht:
18. Juni 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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)
- 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
- 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
- 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
- 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
- 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)
- 18 Plastic surgery statistics. American Society of Plastic Surgeons. . Available at: https://www.plasticsurgery.org/news/plastic-surgery-statistics (PMID: . Accessed September 4, 2018)
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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