We are moving the needle: Improving racial disparities in immediate breast reconstruction.

BACKGROUND: Although racial disparities in receipt of immediate breast reconstruction (IBR) have been previously reported, prior studies may not have fully assessed the impact of recent advocacy efforts as healthcare disparities gain increased national attention. The aim of this study is to assess more recent racial differences and annual trends in receiving IBR. METHODS: Using the National Surgery Quality Improvement Program database, black or white women over 18 years who underwent mastectomy from 2012 to 2021 were included. IBR was defined by undergoing mastectomy with breast reconstruction during the same anesthetic event. Propensity score analysis was utilized to balance variables between black and white patients. A multivariate logistic regression was performed to determine the effect of race on the odds of receiving IBR. RESULTS: The annual percentage of white patients receiving IBR remained stable at around 50% throughout the study period. The annual percentage of black patients receiving IBR increased from 34% in 2012 to 49% in 2021. Compared with white patients, black patients had lower odds of receiving IBR during the entire study period (odds ratio 0.57, 95% confidence interval 0.49-0.67). When assessing annual trends, black patients were less likely to receive IBR each year from 2012 to 2017. By 2021, both races had similar odds of IBR. CONCLUSIONS: Although racial disparities in IBR have been longstanding, this study demonstrates that the racial gap appears to be closing. This may be because of increased awareness of racial disparities and their impact on patient outcomes.

Predictors of blood transfusion in autologous breast reconstruction surgery: A retrospective study using the nationwide inpatient sample database.

BACKGROUND: Specific risk factors associated with the use of blood transfusions during and following autologous breast reconstruction are unknown. The purpose of this study was to evaluate the rate of blood transfusion in autologous breast reconstruction and identify independent risk factors of blood transfusion in autologous breast reconstruction. MATERIALS: A cohort of patients who had undergone autologous breast reconstruction was identified using the Nationwide Inpatient Sample database from 2012 to 2014 in the United States. Univariate and multivariate regression analyses were performed to identify independent risk factors of blood transfusion in this patient population. RESULTS: A total of 55,840 patients underwent autologous breast reconstruction surgery during this period. The overall rate of blood transfusion was 7.0%. Multivariate regression analysis showed that chronic anemia (adjusted odds ratio [AOR], 5.17), congestive heart failure (AOR, 4.07), free flap (AOR, 2.03), chronic kidney disease (AOR, 1.79), hypertension (AOR, 1.39), chronic lung disease (AOR, 1.23), diabetes mellitus (AOR, 1.21), non-teaching hospital (AOR, 1.20), and obesity (AOR, 1.12) were significant risk factors of blood transfusion. There was no association between age, race, liver disease, smoking, chemotherapy, or reconstruction-time on blood transfusion. Patients who received blood transfusion had a significantly higher overall complication rate, longer length of hospital stay, and higher costs than patients who did not receive blood transfusion. CONCLUSIONS: The rate of blood transfusion in autologous breast reconstruction is noticeable (7.0%). Improved awareness of these common risk factors can allow surgeons to identify patients with higher risk to attempt to mitigate complications.