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Racial disparities in the type of postmastectomy reconstruction chosen.
J Surg Res 2015; 195(1):368-76JS

Abstract

BACKGROUND

Racial disparities remain for women undergoing immediate breast reconstruction (IBR) after mastectomy. Understanding patterns of racial disparities in IBR utilization may present opportunities to tailor policies aimed at optimizing care across racial groups. The aim of this study was to determine if racial disparities exist for types of IBR chosen.

METHODS

A national, retrospective cohort study used the 2005-2011 American College of Surgeons National Surgical Quality Improvement Program database. Multivariable logistic regression models were created to detect the odds by race for receiving each subtype of IBR after mastectomy-prosthetic, pedicled-transfer autologous tissue, or free-transfer autologous tissue. Secondary outcome was trends in IBR rates over time.

RESULTS

There were 44,597 women identified in the data set who underwent mastectomy. Thirty-seven percent of women (N = 16, 642) were noted to undergo IBR after mastectomy. Prosthetic reconstruction (84.4%, n = 37, 640) was the most common form of IBR compared with pedicled-autologous reconstruction (15.4%, n = 6868) and free transfer autologous reconstruction (4.9%, n = 2185), P < 0.001. In multivariate analysis, minorities had lower odds of undergoing IBR compared with whites (odds ratio [OR] 0.37 and 95% confidence interval [CI] 0.33-0.42 for Asians, OR 0.57 and 95% CI 0.52-0.61 for blacks, and OR 0.64 and 95% CI 0.58-0.71 for Hispanics, all P < 0.001). Compared with whites, Hispanics (OR 0.70, 95% CI 0.58-0.83) and blacks (OR 0.53, 95% CI 0.46-0.60) were less likely to use prosthetic reconstruction and more likely to use free-transfer autologous reconstruction (OR 1.66, 95% CI 1.26-2.18 for Hispanics, OR 2.13, 95% CI 1.73-2.63 for blacks), all P < 0.001. Racial disparities persisted from 2005-2011; as minority patients were less likely to undergo IBR than whites (P < 0.001).

CONCLUSIONS

Utilization of IBR may be a sensitive measure of disparities in access to high-quality care and underlying cultures. Strategies aimed at reducing racial disparities in IBR should be tailored to specific patterns of disparities among Asian, black, and Hispanic women.

Authors+Show Affiliations

Department of Plastic Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts.Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts.Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.Department of Plastic Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts. Electronic address: Lifei.guo@lahey.org.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25676466

Citation

Offodile, Anaeze C., et al. "Racial Disparities in the Type of Postmastectomy Reconstruction Chosen." The Journal of Surgical Research, vol. 195, no. 1, 2015, pp. 368-76.
Offodile AC, Tsai TC, Wenger JB, et al. Racial disparities in the type of postmastectomy reconstruction chosen. J Surg Res. 2015;195(1):368-76.
Offodile, A. C., Tsai, T. C., Wenger, J. B., & Guo, L. (2015). Racial disparities in the type of postmastectomy reconstruction chosen. The Journal of Surgical Research, 195(1), pp. 368-76. doi:10.1016/j.jss.2015.01.013.
Offodile AC, et al. Racial Disparities in the Type of Postmastectomy Reconstruction Chosen. J Surg Res. 2015 May 1;195(1):368-76. PubMed PMID: 25676466.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial disparities in the type of postmastectomy reconstruction chosen. AU - Offodile,Anaeze C,2nd AU - Tsai,Thomas C, AU - Wenger,Julia B, AU - Guo,Lifei, Y1 - 2015/01/13/ PY - 2014/10/20/received PY - 2014/12/11/revised PY - 2015/01/08/accepted PY - 2015/2/14/entrez PY - 2015/2/14/pubmed PY - 2015/6/13/medline KW - Breast cancer KW - Health policy KW - Immediate breast reconstruction KW - Mastectomy KW - Race KW - Racial disparities SP - 368 EP - 76 JF - The Journal of surgical research JO - J. Surg. Res. VL - 195 IS - 1 N2 - BACKGROUND: Racial disparities remain for women undergoing immediate breast reconstruction (IBR) after mastectomy. Understanding patterns of racial disparities in IBR utilization may present opportunities to tailor policies aimed at optimizing care across racial groups. The aim of this study was to determine if racial disparities exist for types of IBR chosen. METHODS: A national, retrospective cohort study used the 2005-2011 American College of Surgeons National Surgical Quality Improvement Program database. Multivariable logistic regression models were created to detect the odds by race for receiving each subtype of IBR after mastectomy-prosthetic, pedicled-transfer autologous tissue, or free-transfer autologous tissue. Secondary outcome was trends in IBR rates over time. RESULTS: There were 44,597 women identified in the data set who underwent mastectomy. Thirty-seven percent of women (N = 16, 642) were noted to undergo IBR after mastectomy. Prosthetic reconstruction (84.4%, n = 37, 640) was the most common form of IBR compared with pedicled-autologous reconstruction (15.4%, n = 6868) and free transfer autologous reconstruction (4.9%, n = 2185), P < 0.001. In multivariate analysis, minorities had lower odds of undergoing IBR compared with whites (odds ratio [OR] 0.37 and 95% confidence interval [CI] 0.33-0.42 for Asians, OR 0.57 and 95% CI 0.52-0.61 for blacks, and OR 0.64 and 95% CI 0.58-0.71 for Hispanics, all P < 0.001). Compared with whites, Hispanics (OR 0.70, 95% CI 0.58-0.83) and blacks (OR 0.53, 95% CI 0.46-0.60) were less likely to use prosthetic reconstruction and more likely to use free-transfer autologous reconstruction (OR 1.66, 95% CI 1.26-2.18 for Hispanics, OR 2.13, 95% CI 1.73-2.63 for blacks), all P < 0.001. Racial disparities persisted from 2005-2011; as minority patients were less likely to undergo IBR than whites (P < 0.001). CONCLUSIONS: Utilization of IBR may be a sensitive measure of disparities in access to high-quality care and underlying cultures. Strategies aimed at reducing racial disparities in IBR should be tailored to specific patterns of disparities among Asian, black, and Hispanic women. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/25676466/Racial_disparities_in_the_type_of_postmastectomy_reconstruction_chosen_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(15)00053-0 DB - PRIME DP - Unbound Medicine ER -