Samuel Knoedler, Martin Kauke-Navarro, Leonard Knoedler, Sarah Friedrich, Dany Y. Matar, Fortunay Diatta, Vikram G. Mookerjee, Haripriya Ayyala, Mengfan Wu, Bong-Sung Kim, Hans-Guenther Machens, Bohdan Pomahac, Dennis P. Orgill, P. Niclas Broer, Adriana C. Panayi
- 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%)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.…
