Racial disparities in short-term outcomes after breast reduction surgery-A National Surgical Quality Improvement Project Analysis with 23,268 patients using Propensity Score Matching

Valentin Haug; Nikita Kadakia; Alice T Wang; Miguel I Dorante; Adriana C Panayi; Martin Kauke-Navarro; Gabriel Hundeshagen; Yannick F Diehm; Sebastian Fischer; Christoph Hirche; Ulrich Kneser; Bohdan Pomahac

doi:10.1016/j.bjps.2022.01.001

Racial disparities in short-term outcomes after breast reduction surgery-A National Surgical Quality Improvement Project Analysis with 23,268 patients using Propensity Score Matching

J Plast Reconstr Aesthet Surg. 2022 Jun;75(6):1849-1857. doi: 10.1016/j.bjps.2022.01.001. Epub 2022 Jan 16.

Authors

Affiliations

¹ Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
² Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; The Department of Plastic Surgery, Loma Linda University School of Medicine, CA, USA.
³ Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
⁴ Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Plastic and Reconstructive Surgery, Department of Surgery, Lahey Hospital and Medical Center; Burlington, MA, USA.
⁵ Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
⁷ Department of Plastic, Hand and Reconstructive Microsurgery, Hand Trauma and Replantation Center (FESSH), BG Unfallklinik Frankfurt am Main, Germany.
⁸ Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA. Electronic address: bohdan.pomahac@yale.edu.

PMID: 35131191
DOI: 10.1016/j.bjps.2022.01.001

Abstract

Background: Evidence of widespread disparities in healthcare for racial and ethnic minorities is well documented. This study aims to evaluate differences in surgical outcomes after breast reduction surgery (BRS) according to patients' ethnicities.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2005-2018) was utilized to analyze two propensity score matched patient cohorts-White and non-White-that underwent BRS. Preoperative variables assessed included demographic data and comorbidities such as diabetes mellitus, hypertension, and obesity. Postoperative outcomes assessed were medical complications, minor and major surgical complications, as well as mortality.

Results: In total, 23268 patients underwent BRS and met the inclusion criteria. 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 non-White patients (total 14374). After matching, overall 30-day major complications were not significantly different between White and non-White cohort (2.25% vs 2.14%, p=0.65). After accounting for differences in confounding variables at the patient and socioeconomic level, racial and ethnic minorities who underwent breast reduction were found to experience fewer minor surgical complications. The analysis of temporal trends identified an overall rise in the number of patients seeking BRS, with a higher increase noted in the non-White population.

Conclusion: Overall, our findings are reassuring exemptions to prevalent racial and ethnic health inequalities and can serve as a positive example for adequate and fair provision of surgical care.

Keywords: American College of Surgeons National Surgical Quality Improvement Project; Breast reduction surgery; Mammoplasty outcomes; NSQIP; Racial disparities.

MeSH terms

Cohort Studies
Ethnicity
Humans
Mammaplasty*
Postoperative Complications / epidemiology
Propensity Score
Quality Improvement*
Retrospective Studies