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American Association of Plastic Surgeons

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Evaluating Complication Rates In Bilateral Breast Reduction Patients: An Analysis Of Neighborhood-level Disadvantage Using The Area Deprivation Index (ADI)
Victoria G. Zeyl, BA, Krissia M. Rivera Perla, MPH, Raman Mehrzad, MD, MHL, MBA, John J. Slate-Romano, BS, Joseph W. Crozier, MA, Paul Y. Liu, MD, Daniel K. Kwan, MD.
Warren Alpert Medical School of Brown University, Providence, RI, USA.

Purpose: The Area Deprivation Index (ADI) is a validated, quantifiable measure of neighborhood disadvantage and social determinants of health (SDoH). Higher percentiles in ADI correlate with the most disadvantaged neighborhoods: lower income, lower education, and less access to transportation. Using ADI, we aimed to investigate the impact of SDoH on bilateral breast reduction (BBR) complication rates. Methods: A retrospective study of BBR patients from 2016 to 2019 was conducted. Patient addresses were matched to ADI percentiles and grouped into most (top 50% ADI) and least disadvantaged. Multivariable regressions were used to compare outcomes between groups and adjust for confounders. Complications included: wound, seroma, hematoma, scar, infection, necrosis, and drain complications. Results: 230 BBR patients were analyzed. 53.5% were high ADI. The majority of high ADI patients were Black (28.5%) and Latinx (37.4%) in comparison to low ADI patients (13.2% black and 20.8% Latinx; p<0.001). High ADI patients were younger (37 vs 41 years, p=0.14), and had higher BMI (32.7 vs 31.0, p=0.01). High ADI patients had 51% decreased odds of wound complications (OR 0.49, CI 95%=0.24-0.97) and 54% decreased odds of complications overall (OR 0.46, CI 95%=0.23-0.92). Conclusion: We present the only study to our knowledge that uses ADI to quantitively assess SDoH in BBR patients. High ADI patients were younger, with higher BMI, and most often Black and Latinx. Interestingly, they also experienced decreased odds of developing complications. More research is needed to determine the factors that decrease the complications rates in high ADI patients.


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