Outcomes in Breast Reconstruction: Does Race Play a Role? An Analysis of 51,362 Patients from the ACS-NSQIP.
Louise L. Blankensteijn, MD, Sebastian Sparenberg, MD, Dustin T. Crystal, BS, Ahmed MS Ibrahim, MD, PhD, Bernard T. Lee, MD, MBA, MPH, Samuel J. Lin, MD, MBA, FACS.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
PURPOSE: Racial disparities in postoperative complications are widely observed in various surgical specialties. The influence of race is particularly evident and often described in current vascular, orthopedic, and spine surgery literature. Although disparities in access to plastic surgery are well described, the effect of race on plastic surgical outcomes remains largely undefined. This study aims to clarify the influence of race on reconstructive breast surgery outcomes.
METHODS: The NSQIP was queried for all female patients undergoing reconstructive breast surgery between 2008 and 2016. Surgical outcomes of patients of white race were compared to those of African-American, Asian, or other races (composite of American Indian, Alaska Native, Native Hawaiian or Pacific Islander). Logistic regression was performed to control for variations between all groups with a priori selected variables ‘Age', ‘BMI', ‘COPD', ‘Hypertension', ‘Diabetes', ‘Smoking status', ‘Steroid use', ‘Operating Time', and ‘Type of procedure'. Racial differences in outcomes were further stratified and analyzed within four different types of breast reconstruction: delayed or immediate autologous breast reconstruction and delayed or immediate prosthesis-based breast reconstruction.
RESULTS: In total, 51,362 patients were included in the analysis of which 43,864 (85.4%) were white, 5,135 African-American (10.0%), 2,057 Asian (4.0%), and 332 of other races (0.6%). Patients of African-American race had larger body mass indices (31.3 ± 7.0 versus 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% versus 23.4%, p-value <0.001) when compared to white patients. Both univariate and multivariate analysis showed no differences in overall complication rate. When modeling for overall complication rate, the odds ratios (OR) of being of a minority race were not significantly different compared to being white (OR 0.980, 95% CI 0.877-1.095; p-value =0.720, OR 1.035, 95% CI 0.848-1.263; p-value =0.734, OR 0.674, 95% CI 0.395-1.149; p-value =0.147 for African-American, Asian, and other respectively). Moreover, when sub-stratified into different types of reconstruction, no differences were observed.
CONCLUSION: Among the four types of reconstructive procedures, differences in surgical outcomes do not seem to be based on race. Racial disparities in outcomes appear to be less apparent in reconstructive breast surgery compared to the current literature within other surgical specialties.
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