Examining Racial Inequities in Implant-based Breast Cancer Reconstruction

Abstract

Objective: Significant racial disparities persist among implant-based breast cancer reconstruction patients. Proper patient selection remains a large consideration in breast reconstruction. There is paucity of data highlighting differences in implant-based reconstruction outcomes by race. To expand on this knowledge, this study compares three patient risk factors: obesity, diabetes, and smoking, with subsequent complication rates between racial cohorts who received implant-based breast reconstruction. Methods: A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was performed on patients receiving implant-based breast reconstruction determined by primary or concurrent CPT codes 19340, 19342, 19357, and 19380 from 2016-2019. Patients were stratified by race, then assessed for preoperative differences and postoperative outcomes. Patients with an unknown/not reported race were excluded from the analysis. All categorical variables were analyzed using chi-squared or Fisher’s exact test. Significance was determined using a p-value of 0.05. Results: A total of 30,749 patients met the inclusion criteria for our study, 84.3% of which are White. African American, Indigenous or Alaskan Native, and Native Hawaiian or Pacific Islander patients were significantly more likely to present with a BMI over 30 kg/m2 (p<0.0001) than Asian and White patients. African American, Native Hawaiian or Pacific Islander, and Asian patients are significantly more likely to have diabetes (p<0.0001; 14.29%, 11.88%, and 7.77% respectively) than White patients (5.57%). African American patients were the most likely to be active smokers compares to Asian patients (p<0.0001; 9.34% and 4.08% respectively). In terms of complications, Indigenous patients had significantly higher prevalence of infection, reoperation, and readmission compared all other racial groups. African American patients were significantly more likely to encounter wound dehiscence compared to Asian patients (p=0.0075; 1.08% vs. 0.24%). Conclusion: Non-White races had higher rates of obesity, diabetes, and smoking and that correlated to the higher rates of post-operative complications. Further research is needed to investigate if similar preoperative risk factors are also reflected in autologous breast cancer reconstruction patients and if race is a determinant in patient outcomes post breast cancer reconstruction. Corresponding Author: Neej Patel, 411 E 2nd St Apt#112 Flint, MI 48503, [email protected], 7343064487