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Race And Social Vulnerability As Predictors Of Breast Reconstruction Outcomes
Anna G. Boydstun, BA,
Emily E. Hecox, MD, Venkata N. Seerapu, MPH, Benjamin C. McIntyre, MD, FACS.
University of Mississippi Medical Center, Jackson, MS, USA.
PURPOSE: Disparities among racial groups exist in breast cancer reconstruction. This study aims to elucidate the relationship between race and outcomes for patients undergoing breast reconstruction, including disparities present among different reconstructive techniques.
METHODS: A retrospective study was conducted on patients (n=228, 52.6% Black, 45.2% Caucasian, 0.9% Asian, 1.3% other) undergoing first-time post-mastectomy breast reconstruction at a single institution over seven years. Data included demographics, social vulnerability index (SVI), reconstruction methods, and outcomes. Independent t-tests and Chi-square were used for data analysis between Black and all other races. Subgroup analyses were performed based on reconstructive methods including DIEP flaps, LD flaps, direct-to-implant (DTI), tissue expanders (TE) with DIEP, TE with LD, and TE with implants.
RESULTS: Black patients had an overall higher SVI, indicating more social vulnerability than Caucasians (p<0.001). Black patients also presented with a higher BMI (p<0.001), younger age (p=0.035), and were more likely to receive preoperative chemotherapy (p=0.004) and radiation (p=0.045). Black patients were more likely to undergo reconstruction with DIEP flaps (p=0.020) and less likely to undergo DTI (p=0.008). Subgroup analyses demonstrated that Caucasian patients had a greater total number of complications in DIEP flaps (p=0.003), and Black patients had increased time to complete reconstruction in TE with LD flaps (p=0.018).
CONCLUSION: The relationship between race, SVI, increased comorbidities, and earlier presentation indicates that Black patients are more susceptible to adverse health outcomes. A longer time to complete TE and LD reconstruction, which involves additional expansion visits, may indicate inequalities in accessing care among Black patients.
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