Racial and ethnic disparities in hospital outcomes following hospitalizations for mastectomy for breast cancer.

Abstract

e13691 Background: Racial and ethnic disparities in breast cancer (BC) treatment and survival have been well documented. White (W) and Asian (A) women are more likely to have localized BC (BC) than Black (B) or Hispanic (H) women. Furthermore, the incidence of triple negative BC is higher in B women who also have the highest death rates from BC. In this study, we aimed to identify an association between race/ethnicity and outcomes following hospitalization for mastectomy using a large national database. Methods: This study isa retrospective analysis of the National Inpatient Sample database, the largest all-payer inpatient database in the United States, of hospitalizations between 2016-2019. Patients (pts) ≥18 years of age, admitted for mastectomy for BC were included and stratified by race/ethnicity. The outcomes of the study were in-hospital mortality rate, prolonged hospital length of stay, surgical site infection, bleeding complication, cardiac complication, respiratory complication, acute kidney injury, urinary tract infection, and wound dehiscence. Hospitalizations and outcomes were identified using ICD-10 diagnosis and procedure codes. Logistic regression analysis was done to identify an association between race and outcomes. Results: A total of 302,208 pts who were hospitalized for mastectomy were included. Of these 218,092 (72.2%) pts were W, 36,242 (12.0%) were B, 25,130 (8.3%) were Hispanics, and 22,744 (7.5%) were of another race. Among B pts, adverse outcomes were significantly higher (p<0.001), including in-hospital mortality rate (0.2%), prolonged hospital length of stay (64.1%), surgical site infection (0.8%), bleeding complication (4.2%), cardiac complication (0.8%), respiratory complication (0.3%), and acute kidney injury (1.4%). After adjusting for various factors including age, insurance, hospital region, hypertension, diabetes, obesity, peripheral vascular disease, alcohol use, Elixhauser comorbidity index, whether pts underwent axillary lymph node dissection and others, logistic regression was performed. This analysis identified that B pts had significantly higher odds for mortality (adjusted odds ratio [aOR], 2.99, 95% CI: 1.62-5.73), prolonged hospital length of stay (aOR, 1.32, 95% CI: 1.18-1.49), and bleeding complication (aOR, 1.28, 95% CI: 1.13-1.48). Conclusions: Results of our study show that adverse hospital outcomes following mastectomy for BC were significantly higher among Black patients. These outcomes remained significant after adjusting for clinical covariates, raising the possibility of other contributing factors to these differences in outcomes. Study limitations include the lack of information on stage at diagnosis, receptor status, and that Hispanics were categorized under race. Further studies are needed to develop effective interventions to reduce these disparities.