Racial Disparities in Postoperative Breast Reconstruction Outcomes: A National Analysis

• Published in: Journal of racial and ethnic health disparities Vol. 11; no. 3; pp. 1199 - 1210
• Main Authors: Johnstone, Thomas, Thawanyarat, Kometh, Rowley, Mallory, Francis, Shannon, Camacho, Justin M., Singh, Dylan, Navarro, Yelissa, Shah, Jennifer K., Nazerali, Rahim S.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-06-2024; Springer Nature B.V
• Subjects: Adult; Age; Age differences; Age factors; Aged; Asian - statistics & numerical data; Black or African American - statistics & numerical data; Black people; Breast; Breast cancer; Breast Neoplasms - ethnology; Breast Neoplasms - surgery; Breast reconstruction; Comorbidity; Complications; Confidence intervals; Demographics; Demography; Dependent variables; Diabetes; Diabetes mellitus; Epidemiology; Ethnicity; Female; Health disparities; Healthcare Disparities - ethnology; Healthcare Disparities - statistics & numerical data; Hematoma; Hemorrhage; Hispanic or Latino - statistics & numerical data; Humans; Hypertension; Inequality; Infections; Mammaplasty - statistics & numerical data; Mastectomy; Medical history; Medical records; Medicine; Medicine & Public Health; Middle Aged; Minority & ethnic groups; Necrosis; Patients; Population studies; Postoperative; Postoperative Complications - epidemiology; Postoperative Complications - ethnology; Quality of Life Research; Race; Race factors; Racial differences; Racial groups; Racial Groups - statistics & numerical data; Racial inequality; Regression analysis; Risk Factors; Social Inequality; Social Structure; Socioeconomic factors; Socioeconomic status; Statistical analysis; Surgical outcomes; Thrombosis; Tobacco; Type 2 diabetes mellitus; United States - epidemiology; White People - statistics & numerical data; Wound dehiscence; United States; United States > US; Implant based; Breast cancer; Racial disparities; Breast reconstruction
• ISSN: 2197-3792; 2196-8837; 2196-8837
• DOI: 10.1007/s40615-023-01599-1

Background
Studies have shown that Black patients are more likely to experience complications following breast reconstruction compared to other racial groups. Most of these studies have been conducted on patient populations focusing on either autologous or implant-based reconstruction without possible predictive indicators for complication disparities for all types of reconstruction procedures. The aim of this study is to elucidate disparities among patient demographics by identifying predictors of complications and postoperative outcomes among different racial/ethnic patients undergoing breast reconstruction utilizing multi-state, multi-institution, and national level data.
Methods
Patients in the Optum Clinformatics Data Mart that underwent all billable forms of breast reconstruction were identified via CPT codes. Demographics, medical history, and postoperative outcome data were collected by querying relevant reports of CPT, ICD-9, and ICD-10 codes. Outcomes analysis was limited to the 90-day global postoperative period. A multivariable logistic-regression analysis was performed to ascertain the effects of age, patient reported ethnicity, coexisting conditions, and reconstruction type on the likelihood of any common postoperative complication occurring. Linearity of the continuous variables with respect to the logit of the dependent variable was confirmed. Odds ratios and corresponding 95% confidence intervals were calculated.
Results
From over 86 million longitudinal patient records, our study population included 104,714 encounters for 57,468 patients who had undergone breast reconstruction between January 2003 and June 2019. Black race (relative to White), autologous reconstruction, hypertension, type II diabetes mellitus, and tobacco use were independent predictors of increased likelihood of complication. Specifically, the odds ratios for complication occurrence for Black, Hispanic, and Asian ethnicity (relative to White) were 1.09, 1.03, and 0.77, respectively. Black patients had an overall breast reconstruction complication rate of 20.4%, while the corresponding rate for White, Hispanic, and Asian patients were 17.0%, 17.9%, and 13.2%, respectively.
Conclusion
Our analysis of a national-level database shows that Black patients undergoing implant-based or autologous reconstruction have increased risk of complications, likely due to multifactorial components that play a role in the care of this patient population. While higher rates of comorbidities have been cited as a possible cause, providers must consider racial influences involving cultural context, historical mistrust in medicine, and physician/health institution factors that may drive this disparity of outcomes among our patients.