Schafer Rachel E, Ho Isabel, Potoczak Patrick S, Misra-Hebert Anita, Nowacki Amy S, Schwarz Graham S
From the Lerner College of Medicine.
Departments of Plastic Surgery.
Plast Reconstr Surg. 2025 May 1;155(5):854e-862e. doi: 10.1097/PRS.0000000000011815. Epub 2024 Oct 15.
Breast reconstruction following mastectomy for the treatment of breast cancer restores form and enhances patient satisfaction. The Affordable Care Act (ACA) of 2010 aimed to have an impact on trends in breast reconstruction, but recent information regarding racial and ethnic disparities is lacking.
The authors analyzed National Surgical Quality Improvement Program data spanning 2005 to 2022 to investigate the impact of the ACA on racial and ethnic diversity in immediate breast reconstruction following mastectomy. Patient demographics, including race and ethnicity, were considered. Statistical analyses included Pearson chi-square tests and multivariable logistic regressions to assess trends and disparities over time.
In total, 224,506 patients met inclusion criteria. Analysis revealed that in the pre-ACA era, American Indian or Alaska Native, Asian, and black or African American individuals underwent immediate breast reconstruction at lower rates compared with white patients ( P < 0.001). In addition, Hispanic patients were less likely to undergo breast reconstruction compared with non-Hispanic patients (28.0% versus 33.4%; P < 0.001). In the post-ACA period, this trend persisted, with all racial groups undergoing immediate breast reconstruction at lower rates compared with white patients ( P < 0.001). However, Hispanic patients were more likely to undergo immediate breast reconstruction compared with non-Hispanic patients (53.8% versus 47.9% ; P < 0.001).
Despite legislative efforts and a steady increase in immediate breast reconstruction rates over the years, racial disparities in breast reconstruction rates persist, highlighting the need for ongoing monitoring and targeted interventions to ensure equitable reconstructive care for all patients.
乳腺癌乳房切除术后进行乳房重建可恢复外形并提高患者满意度。2010年的《平价医疗法案》（ACA）旨在对乳房重建趋势产生影响，但目前缺乏有关种族和民族差异的最新信息。
作者分析了2005年至2022年的国家外科质量改进计划数据，以研究ACA对乳房切除术后即刻乳房重建中种族和民族多样性的影响。考虑了患者的人口统计学特征，包括种族和民族。统计分析包括Pearson卡方检验和多变量逻辑回归，以评估随时间的趋势和差异。
共有224,506名患者符合纳入标准。分析显示，在ACA实施前的时代，与白人患者相比，美国印第安人或阿拉斯加原住民、亚洲人以及黑人或非裔美国人进行即刻乳房重建的比例较低（P<0.001）。此外，与非西班牙裔患者相比，西班牙裔患者进行乳房重建的可能性较小（28.0%对33.4%；P<0.001）。在ACA实施后，这一趋势仍然存在，所有种族群体进行即刻乳房重建的比例均低于白人患者（P<0.001）。然而，与非西班牙裔患者相比，西班牙裔患者更有可能进行即刻乳房重建（53.8%对47.9%；P<0.001）。
尽管有立法努力且多年来即刻乳房重建率稳步上升，但乳房重建率的种族差异仍然存在，这凸显了持续监测和针对性干预的必要性，以确保为所有患者提供公平的重建护理。
