Do Racial Disparities in outcomes of Reduction Mammoplasty exist? A propensity matched analysis of 14374 patients
Nikita Kadakia, BS1, Valentin Haug, MD2, Alice Wang, BS3, Miguel Dorante, MD4, Yannick Diehm, MD4, Gabriel Hundeshagen, MD MMS2, Sebastian Fischer, MD MHBA2, Christoph Hirche, MD2, Ulrich Kneser, MD2, Bohdan Pomahac, MD4.
1University of California Riverside School of Medicine, Riverside, CA, USA, 2Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany, 3Harvard Medical School, Boston, MA, USA, 4Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA.
BACKGROUND: Racial and socioeconomic disparities in plastic surgery have been reported in patients undergoing breast cancer surgery, including breast reconstruction. Given that these differences exist for reconstructive plastic surgery, we found it imperative to evaluate racial variations in outcomes following reduction mammoplasty, one of the most common aesthetic surgery procedures. In our study, we seek to provide a robust statistical analysis evaluating the association of race and 30-day postoperative complications in female patients undergoing reduction mammoplasty. METHODS: Female patients who underwent reduction mammoplasty in the 2005-2018 American College of Surgeons National Surgical Quality Improvement Program were identified. Patients, in which race/ethnicity was not defined were excluded. White and nonwhite patient cohorts were matched 1:1 using propensity score analysis to assess outcomes. Outcomes of interest included medical and surgical complications, reoperation, and mortality within 30 days postoperatively. Univariate analysis was used to identify variations in outcomes between the two groups. RESULTS: Of 38419 patients, who underwent reduction mammoplasty, a total of 23268 female patients met inclusion criteria. In the overall cohort, there were significant differences in preoperative comorbidities. Non-white patients were more likely to have higher BMI, diabetes mellitus, hypertension, poor nutrition, higher ASA status, inpatient admission, and younger age at surgery. Poor nutrition was defined as BMI ≤18.5 kg/m2, albumin <3.5 mg/dL or weight loss >10% in 6 months, preoperatively. After propensity score matching, the two cohorts were matched with respect to these preoperative variables; and, 7187 patients were included in each cohort of White and nonwhite patients. More White patients were smokers (p=0.01). After matching, overall 30-day major complications were not significantly different between white and nonwhite cohort (2.25% vs 2.14%, p=0.65). Minor surgical complications, including superficial surgical site infections, were higher in White women (2.57% vs 1.70; p<0.0001). Medical complications, including cardiovascular, pulmonary, renal, and systemic (sepsis/septic shock) were similar in the white and nonwhite cohort. The proportion of nonwhite patients increased from 39.9% in 2005 to 52.9% in 2018. CONCLUSIONS:
Despite reports of racial disparities in outcomes following general surgery procedures including breast surgery, in our study, nonwhite patients undergoing reduction mammoplasty had 30-day post-operative outcomes that were comparable to White patients. Minor surgical complication rates were better in nonwhite women, which may be attributable to bias due to fewer follow-up visits. Overall, the increasing proportion of nonwhite patients in this quality-of-life improving surgery suggests improved accessibility for non-white patients over the last 14 years.
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