Impact of Sociodemographic and Clinical Factors on Postoperative Outcomes Following Immediate Postmastectomy Autologous Breast Reconstruction.

BACKGROUND

Postmastectomy autologous reconstruction (PMAR) is an important component of comprehensive breast cancer care. Previous research has suggested the existence of sociodemographic disparities in complications after immediate PMAR. The objective of this study was to examine the impact of sociodemographic and clinical factors on immediate PMAR postoperative outcomes.

METHODS

We performed a retrospective cohort study of adult patients undergoing PMAR in the Healthcare Cost and Utilization Project Florida State Inpatient Database (2016-2021). Postmastectomy autologous reconstruction included deep inferior epigastric perforator (DIEP), transverse rectus abdominis myocutaneous (TRAM), and latissimus dorsi (LD) flaps. Primary outcomes were inpatient postoperative complications and readmissions within 30 and 90 days. Data elements were abstracted by using ICD-10 codes and comorbidities defined by using the Elixhauser classification. Univariate and multivariate analyses were performed.

RESULTS

We identified 3537 women admitted for PMAR. 483 (13.7%) patients experienced complications 30 days postsurgery. An additional 46 patients (15%) experienced complications within 90 days. A total of 224 patients (6.3%) were readmitted within 30 days, and 368 (10.4%) were readmitted within 90 days. Patients living in smaller metropolitan areas or with four or more comorbidities had significantly increased odds of complications. Patients with Medicaid, Medicare, or two or more comorbidities were significantly more likely to experience hospital length of stay ≥7 days. Residing in smaller metropolitan areas, having two or more comorbidities, or having Medicare were associated with increased odds of 30-day and 90-day readmission.

CONCLUSIONS

Disparities exist in outcomes after PMAR in patients with public insurance, residing in smaller metropolitan areas, and with multiple comorbidities. These findings should be further evaluated to assess validity and determine generalizability.