Racial Disparities in Surgical Outcomes after Mastectomy in 223,000 Female Breast Cancer Patients – A Retrospective Cohort Study
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- General Medicine
- Surgery
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:
We 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=1,198) American Indian/Alaska Native, and 0.5% (n=1,018) 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=7,246; 3.3%). Multivariable analysis revealed that being of Asian race was protective against perioperative complications (OR=0.71;
Conclusion:
We 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. Our analyses revealed comparable confounder-adjusted outcomes following partial and complete mastectomy between Black and white races. Our findings call for care equalization in the field of breast cancer surgery.