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. 2024 Feb 1;110(2):684-699.
doi: 10.1097/JS9.0000000000000909.

Racial disparities in surgical outcomes after mastectomy in 223 000 female breast cancer patients: a retrospective cohort study

Samuel Knoedler  1   2   3 , Martin Kauke-Navarro  3 , Leonard Knoedler  4   3 , Sarah Friedrich  5 , Dany Y Matar  2 , Fortunay Diatta  3 , Vikram G Mookerjee  3 , Haripriya Ayyala  3 , Mengfan Wu  2   6 , Bong-Sung Kim  7 , Hans-Guenther Machens  1 , Bohdan Pomahac  3 , Dennis P Orgill  2 , P Niclas Broer  8 , Adriana C Panayi  2
Affiliations

Racial disparities in surgical outcomes after mastectomy in 223 000 female breast cancer patients: a retrospective cohort study

Samuel Knoedler et al. Int J Surg. .

Abstract

Background: Breast cancer mortality and treatment differ across racial groups. It remains unclear whether such disparities are also reflected in perioperative outcomes of breast cancer patients undergoing mastectomy.

Study design: The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008-2021) to identify female patients who underwent mastectomy for oncological purposes. The outcomes were stratified by five racial groups (white, Black/African American, Asian, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander) and included 30-day mortality, reoperation, readmission, surgical and medical complications, and non-home discharge.

Results: The study population included 222 947 patients, 68% ( n =151 522) of whom were white, 11% ( n =23 987) Black/African American, 5% ( n =11 217) Asian, 0.5% ( n =1198) American Indian/Alaska Native, and 0.5% ( n =1018) Native Hawaiian/Pacific Islander. While 136 690 (61%) patients underwent partial mastectomy, 54 490 (24%) and 31 767 (14%) women received simple and radical mastectomy, respectively. Overall, adverse events occurred in 17 222 (7.7%) patients, the largest portion of which were surgical complications ( n =7246; 3.3%). Multivariable analysis revealed that being of Asian race was protective against perioperative complications [odds ratio (OR)=0.71; P <0.001], whereas American Indian/Alaska Native women were most vulnerable to the complication occurrence (OR=1.41; P <0.001). Black/African American patients had a significantly lower risk of medical (OR=0.59; P <0.001) and surgical complications (OR=0.60; P <0.001) after partial and radical mastectomy, respectively, their likelihood of readmission (OR=1.14; P =0.045) following partial mastectomy was significantly increased.

Conclusion: The authors identified American Indian/Alaska Native women as particularly vulnerable to complications following mastectomy. Asian patients experienced the lowest rate of complications in the perioperative period. The authors' analyses revealed comparable confounder-adjusted outcomes following partial and complete mastectomy between Black and white races. Their findings call for care equalization in the field of breast cancer surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

None
Graphical abstract
Figure 1
Figure 1
Flow diagram of the screening and selection process. CPT, Current Procedural Terminology.
Figure 2
Figure 2
Racial comparison of the operative time in partial, simple, and radical mastectomy. Exact numbers and statistical comparisons are provided in the Supplementary Table 1 and 2.
Figure 3
Figure 3
Racial comparison of the length of hospital following the three different types of mastectomy. Exact numbers and statistical comparisons are provided in the Supplementary Table 3 and 4.
Figure 4
Figure 4
Graphical illustration of the results of the multivariable analyses. Table 5 shows the exact numbers.
See this image and copyright information in PMC

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