Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Clin Breast Cancer. 2024 Oct;24(7):604-610. doi: 10.1016/j.clbc.2024.06.017. Epub 2024 Jun 26.
The Area Deprivation Index (ADI) ranks neighborhoods by deprivation based on US Census data. This study utilizes ADI scores to investigate the impact of neighborhood deprivation on complication rates following breast reconstruction.
Patients who received implant-based reconstruction from 2019 to 2023 were identified at a single institution in New York. Patients were linked to a state-specific ADI score and categorized into groups: "High ADI" (6-10) and "Low ADI" (1-5). Patient characteristics and complication rates were compared between the ADI groups with Chi-Square analysis and t-tests. The predictive value of ADI scores on complication rates was assessed using logistic regression models.
In total, 471 patients were included, of which 16% (n = 73) were in the High ADI group, and 84% (n = 398) were in the Low ADI group. There were no baseline differences between the 2 groups, except that there were more patients of Hispanic descent in the High ADI group (30% vs. 15%, P < .01). The High ADI group had a higher overall complication rate than the Low ADI group (34% vs. 21%, P < .01), as well as higher individual rates of hematoma (12% vs. 3%, P < .01) and unexpected reoperations (18% vs. 7%, P < .01). After adjusting for differences in race, High ADI scores predicted hematoma, reoperations, and any complication (P < .05).
Patients living in neighborhoods with high ADI had a higher incidence of postoperative complications, independent of comorbidities and race. This measure of disparity should be considered when counselling patients about their risk of complications following procedures like implant-based breast reconstruction.
区域剥夺指数（ADI）根据美国人口普查数据对贫困社区进行排名。本研究利用 ADI 评分来调查社区贫困对乳房重建后并发症发生率的影响。
在纽约的一家单机构中，确定了 2019 年至 2023 年期间接受基于植入物的重建的患者。患者与特定于州的 ADI 评分相关联，并分为两组：“高 ADI”（6-10）和“低 ADI”（1-5）。使用卡方分析和 t 检验比较 ADI 组之间的患者特征和并发症发生率。使用逻辑回归模型评估 ADI 评分对并发症发生率的预测价值。
共纳入 471 例患者，其中 16%（n=73）为高 ADI 组，84%（n=398）为低 ADI 组。两组之间没有基线差异，除了高 ADI 组中有更多的西班牙裔患者（30%比 15%，P<.01）。高 ADI 组的总并发症发生率高于低 ADI 组（34%比 21%，P<.01），且血肿（12%比 3%，P<.01）和意外再次手术（18%比 7%，P<.01）的发生率也更高。在调整种族差异后，高 ADI 评分预测血肿、再次手术和任何并发症（P<.05）。
生活在 ADI 较高的社区的患者术后并发症发生率较高，与合并症和种族无关。在为接受植入物乳房重建等手术的患者提供咨询时，应考虑这种差异的衡量标准。
