From the Section of Plastic Surgery, Department of Surgery, University of Chicago Medical Center.
Plast Reconstr Surg. 2023 Jan 1;151(1):217-224. doi: 10.1097/PRS.0000000000009761. Epub 2022 Oct 20.
Previous studies have demonstrated racial disparities in breast cancer treatment and secondary lymphedema. However, no studies have yet examined the effects of race and socioeconomic status on physiological surgical treatment for lymphedema. The authors aimed to evaluate whether disparities exist within patients seeking physiological surgical lymphedema treatment.
A retrospective review was performed of patients presenting for physiological surgical treatment of lymphedema from 2013 to 2019. Data on demographics, medical history, socioeconomic factors, lymphedema, and treatments were collected.
A total of 789 patients (712 women and 77 men) seeking physiological surgical treatment of lymphedema were selected. Their mean age was 54.4 ± 13.4 years. A total of 620 patients (78.5%) self-reported as White, 120 (15.2%) as Black, 17 (2.2%) as Asian, five (0.6%) as Hispanic, and eight (2.4%) as multiracial. A total of 566 patients (71.7%) met criteria for surgical candidacy. White race was associated with increased rates of surgical candidacy compared with Black race (46.6% versus 77.2%; P < 0.0001). Compared with White patients, Black patients presented with a longer symptom duration (11.07 versus 6.99 years; P < 0.001), had a higher body mass index (mean, 34.5 versus 28.1; P < 1 × 10 -10 ), had a higher International Society of Lymphology stage ( P < 0.05), and were less likely to have maximized medical treatment for lymphedema (30.8% versus 55.4%; P < 0.01).
This study demonstrates racial disparities in patients seeking physiological surgical treatment for lymphedema. Black patients present later with more severe disease, receive less nonsurgical treatment before consultation, and are less likely to meet criteria for physiological surgery. Improved patient and provider education on lymphedema and appropriate diagnosis and nonsurgical treatment is of primary importance to address this disparity.
先前的研究表明，乳腺癌治疗和继发性淋巴水肿存在种族差异。然而，目前尚无研究探讨种族和社会经济地位对淋巴水肿生理手术治疗的影响。作者旨在评估寻求生理手术淋巴水肿治疗的患者中是否存在差异。
对 2013 年至 2019 年期间因淋巴水肿接受生理手术治疗的患者进行回顾性研究。收集人口统计学、病史、社会经济因素、淋巴水肿和治疗等数据。
共选择了 789 名（712 名女性和 77 名男性）寻求生理手术治疗淋巴水肿的患者。他们的平均年龄为 54.4 ± 13.4 岁。620 名患者（78.5%）自我报告为白人，120 名（15.2%）为黑人，17 名（2.2%）为亚洲人，5 名（0.6%）为西班牙裔，8 名（2.4%）为多种族。共有 566 名（71.7%）符合手术条件。与黑人相比，白人种族的手术合格率更高（46.6%比 77.2%；P < 0.0001）。与白人患者相比，黑人患者的症状持续时间更长（11.07 年比 6.99 年；P < 0.001），体重指数更高（平均 34.5 比 28.1；P < 1 × 10 -10 ），国际淋巴学会分期更高（P < 0.05），接受淋巴水肿最大程度非手术治疗的可能性更低（30.8%比 55.4%；P < 0.01）。
本研究表明，寻求淋巴水肿生理手术治疗的患者存在种族差异。黑人患者就诊时病情更严重，更晚期，在咨询前接受的非手术治疗较少，并且不太可能符合生理手术的标准。提高患者和提供者对淋巴水肿的认识以及适当的诊断和非手术治疗至关重要，以解决这一差异。
