University of Wisconsin–Madison Medical College of Wisconsin

Evaluation of Racial Disparities in Postoperative Outcomes Following Breast Reconstruction at a Single Institution in Wisconsin

Zeeda H. Nkana, BS; Kasey Leigh Wood, BS; Alison M. Karczewski, BS; Kirsten A. Gunderson, BS; Sarah M. Lyon, MD; Aaron M. Dingle, PhD; Samuel O. Poore, MD, PhD

WMJ. 2021;120(Suppl 1):S42-S47.

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ABSTRACT

Introduction: Breast cancer is the most common cancer in women in Wisconsin. Evidence demonstrates that non-White racial minorities in the United States exhibit a higher mortality rate and more advanced or aggressive presentations of the disease than their White counterparts. Postmastectomy breast reconstruction remains essential to the treatment and recovery of these patients; however, racial disparities in the receipt of reconstruction are evident. This study evaluates the presence of racial disparities in postoperative outcomes of breast reconstruction at a single institution in Wisconsin.

Methods: An institutional review board-exempt retrospective study of postoperative outcomes was performed using a single institution’s National Surgical Quality Improvement Program Registry to identify patients who underwent autologous or prosthesis-based breast reconstruction following mastectomy. Patient demographic, preoperative, operative, and postoperative variables were recorded. Postoperative outcomes in relation to self-reported race were evaluated using univariate analysis and propensity score matching.

Results: A total of 1,140 patients were included (1,092 White vs 48 non-White), with fewer non-White patients undergoing reconstruction. Patients of non-White race demonstrated a higher incidence of morbid obesity (4.4% White vs 12.5% non-White, P = 0.010) and bleeding disorders (0.3% White vs 4.2% non-White, P < 0.001). No association between self-reported race and postoperative complication was found.

Conclusion: This study did not reveal racial disparities in postoperative outcomes of breast reconstruction at a single institution in Wisconsin; however, non-White patients were less likely to undergo reconstruction. Further research into the underlying causes of unequal access to care, influence of insurance, effect of structural racism, and impact of physician- and patient-associated factors is warranted.


Author Affiliations: University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Madison, Wis (Nkana, Wood, Karczewski, Gunderson, Lyon, Dingle, Poore).
Corresponding Author: Samuel O. Poore, MD, PhD, University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, 600 Highland Ave, G5-347 Clinical Sciences Center, Madison, WI 53711, phone 608.265.2535; email poore@surgery.wisc.edu; Twitter @drsamuelpoore.
Acknowledgements: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes for Health.
Funding/Support: The project described was supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR002373.
Financial Disclosures: None declared.
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