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Key Differences in the Reporting of Racial and Socioeconomic Disparities Among 3 Large National Databases for Breast Reconstruction
Parisa Kamali, MD1, Sara L. Zettervall, MD, MPH1, Ahmed M.S. Ibrahim, MD, PhD2, Winona Wu, BSc1, Caroline Medin, BSc1, Marc L. Schermerhorn, MD3, Hinne A. Rakhorst, MD, PhD4, Bernard T. Lee, MD, MBA, MPH, FACS1, Samuel J. Lin, MD, MBA, FACS1.
1Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA, USA, 2Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center., New Orleans, LA, USA, 3Divison of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA, 4Division of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Twente, Netherlands.

Background:
In breast cancer research, the Nationwide Inpatient Sample (NIS) database, the National Surgical Quality Improvement Program (NSQIP), and the Surveillance, Epidemiology and End Result (SEER) program are widely utilized. These databases allow study of patterns of care, variation in practice, and surgical outcomes. This study aims to compare the trends in immediate breast reconstruction (IBR) and identify the drawbacks and benefits of each database.
Methods:
ICD-9 codes were used to identify patients with invasive breast cancer (BC) and ductal carcinoma In-Situ (DCIS) from 2005 to 2012 from each database. Trends of IBR over time were evaluated. Patient demographics and co-morbidities were compared. Subgroup analysis of IBR utilization stratified per race was conducted.
Results:
1.2 million patients were studied (607,867 BC and 86,733 DCIS in NIS, 38,567 BC and 7,173 DCIS in NSQIP, and 439,564 BC and 108,482 DCIS in SEER). IBR in BC patients increased significantly over time from 2005 to 2012 in all databases (NIS 19.3% to 47.0%, NSQIP 30.3% to 48.6%, SEER 12.2% to 24.9%, respectively (p<0.001))(figure 1). Similar trend over time was seen in DCIS patients. Significant disparities was seen in IBR rates among different races: Caucasian (35.7%, 43.1%, 20.6%; p<0.001), Black (27.3%, 30.7% and 15.5%; p<0.001), Hispanic (30.8%, 40.3%, 12.9%; p<0.001) and Asian (30.5%, 32.1%, 14.0%,p<0.001) in the NIS, NSQIP and SEER, respectively (Figure 2). Similar disparities were seen in the DCIS cohort. Rates of co-morbidities were similar in NSQIP, NIS and SEER (Table 1).
Conclusion:
There has been a significant increase in IBR rates, however, the extent of racial disparities differ significantly among databases. The NIS and NSQIP reporting results appear to be more similar with their results in reporting breast reconstruction findings with the SEER reporting results significantly lower in several categories. These findings suggest that utilization of SEER may not be universally generalizable to the entire US population.


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