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

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.

Racial Disparities in the 30-Day Outcomes of Gender-affirming Chest Surgeries

“…Our results differ from other published reports looking at overall racial disparities in chest surgeries, 32 which did not find racial differences in the complications of breast procedures performed in the NSQIP database. This difference is possibly due to the fact that previous research examined only all-cause complications rather than individual complications in the NSQIP.…”

“…Overall, both of our study cohorts were relatively healthy, with >90% of the overall sample classified as ASA Class 1 or 2. In contrast, previous research on breast reconstruction has indicated fairly high rates of comorbidities and overall poorer health 32,33…”

Persistent Disparities in Postmastectomy Breast Reconstruction and Strategies for Mitigation

“…In addition to challenges with access to breast reconstruction, AA patients have been shown to have increased comorbidities, equivocal clinical outcomes, and decreased preoperative and postoperative satisfaction compared with white patients. 8,15,25,[33][34][35][36] Numerous studies have demonstrated higher levels of hypertension, diabetes, increased BMI, and smoking among AA patients compared with white patients. 3,8,34,35,37 These, in addition to other differences in preoperative risk factors, such as heart disease, pulmonary disease, and chronic kidney disease, have further informed our understanding of the impact of socioeconomic factors on general health, wellness, and adequate provision of care.…”

“…8,15,25,[33][34][35][36] Numerous studies have demonstrated higher levels of hypertension, diabetes, increased BMI, and smoking among AA patients compared with white patients. 3,8,34,35,37 These, in addition to other differences in preoperative risk factors, such as heart disease, pulmonary disease, and chronic kidney disease, have further informed our understanding of the impact of socioeconomic factors on general health, wellness, and adequate provision of care. 18,20,[38][39][40][41] Despite increased comorbidities and risk factors, studies comparing postoperative complications after breast reconstructive between racial and ethnic groups are inconclusive.…”

“…33 While a couple of studies have found higher rates of postoperative complications for AA women, others have found no significant differences in clinical outcomes. 8,15,[33][34][35][36] reconstructions and found that AA and Latino patients had higher rates of any complication, in addition to increased rates of partial flap necrosis, arterial insufficiency, and venous insufficiency. 8 Similarly, Wu et al analyzed 138 women who underwent either pedicled transverse rectus abdominis myocutaneous (pTRAM) or deep inferior epigastric perforator (DIEP) flap breast reconstruction to determine the relationship between race and ischemic complications.…”