Racial and Ethnic Disparities in Surgical Outcomes after Postmastectomy Breast Reconstruction

Abstract

BACKGROUND: Women of color with breast cancer are less likely to undergo post-mastectomy reconstruction compared with White women, but it is unclear whether their perioperative outcomes are worse. The goal of this study was to investigate differences in preoperative comorbidities and postoperative complications by race/ethnicity among women with breast cancer undergoing postmastectomy reconstruction. STUDY DESIGN: Data were collected from the National Inpatient Sample database of the Healthcare Cost and Utilization Project from 2012 to 2016. Patient demographics, types of reconstruction, comorbid conditions, Charlson-Deyo Combined Comorbidity (CDCC) scores, length of stay (LOS), and perioperative complications were abstracted. Multivariate linear and logistic regression were performed to model LOS and likelihood of postoperative complications, respectively. RESULTS: Compared with White women (n = 19,730), Black women (n = 3,201) underwent autologous reconstruction more frequently (40.7% vs 28.3%), had more perioperative comorbidities (eg diabetes: 12.9% vs 5.8%), higher CDCC scores (% CDCC ≥ 4: 5.5% vs 2.7%), and longer LOS (median 3 vs 2 days, all p < 0.001). Being Black (vs White: +0.13 adjusted days, 95% CI 0.06 to 0.19) was also associated with longer LOS and an increased likelihood of surgical complications (vs White: odds ratio 1.24, 95% CI 1.09 to 1.42, both p < 0.01), but this association did not persist when outcomes were limited to microsurgical complications. CONCLUSION: Disparities in postmastectomy breast reconstruction between Black and White women extend beyond access to care and include perioperative factors and outcomes. These findings suggest an important opportunity to mitigate inequities in reconstruction through perioperative health optimization and improved access to and co-management with primary care.

A Novel Method to Determine Patient Skin Type: The Skin Analyzer

“…Existing research on skin color in the field of plastic surgery has shown that it can be an important factor not only in health equity but also in the prevalence of disease, patient risk for certain conditions, and patient outcomes, 2,[16][17][18] but such investigations are hindered by difficulty collecting objective and consistent data on skin color. It has been reported that plastic surgery journals use significantly more images of white-skinned than dark-skinned individuals.…”

Allostatic Load as a Predictor of Postoperative Complications in Patients with Breast Cancer

“…For example, Black women undergoing breast surgery are more likely to have longer lengths of stay, develop POCs, and experience higher in-hospital mortality than White women. 6,7 Similarly, patients living in areas of high deprivation report poorer psychosocial well-being and physical functioning after breast surgery than their counterparts living in areas with less deprivation. 8 A plausible explanation for these racial and socioeconomic disparities in postoperative outcomes is an interplay between greater rates of comorbidities and higher socioenvironmental stressors (e.g., low socioeconomic status) often experienced by marginalized and minoritized women.…”

The impact of rural structural and community health factors on postmastectomy complications among south central Appalachian breast cancer patients

“…1,16 Previous research analyzing predictors of postmastectomy complications have primarily focused on individual-level risk factors (e.g., BMI, diabetes, age, and medical comorbidities), 7 with few examining the influence of economic deprivation 22,26 and racial/ethnic disparities. 27 However, there is a lack of research regarding the influence of geographic disparities, such as rural status, and structural community…”