Racial disparities in the use of outpatient mastectomy.
BACKGROUND
Racial disparities exist within many domains of cancer care. This study was designed to identify differences in the use of outpatient mastectomy (OM) based on patient race.


METHODS
We identified patients in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (during the years 2007-2010) who underwent a mastectomy. The association between mastectomy setting, patient race, patient age, American Society of Anesthesiology physical status classification, functional status, mastectomy type, and hospital teaching status was determined using the chi-square test. A multivariable logistic regression analysis was developed to assess the relative odds of undergoing OM by race, with adjustment for potential confounders.


RESULTS
We identified 47,318 patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File who underwent a mastectomy during the study time frame. More than half (62.6%) of mastectomies were performed in the outpatient setting. All racial minorities had lower rates of OM, with 63.8% of white patients; 59.1% of black patients; 57.4% of Asian, Native Hawaiian, or Pacific Islander patients; and 43.9% of American Indian or Alaska Native patients undergoing OM (P < 0.001). After adjustment for multiple confounders, black patients, American Indian or Alaska Native patients, and those of unknown race were all less likely to undergo OM (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.80-0.93; OR, 0.55; 95% CI, 0.41-0.72; and OR, 0.70; 95% CI, 0.64-0.76, respectively) compared with white patients.


CONCLUSIONS
Disparities exist in the use of OM among racial minorities. Further studies are needed to identify the role of cultural preferences, physician attitudes, and insurer encouragements that may influence these patterns of use.
Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Vanessa
V
Salasky
Rachel L
RL
Yang
Jashodeep
J
Datta
Holly L
HL
Graves
Jessica A
JA
Cintolo
Chelsey
C
Meise
Giorgos C
GC
Karakousis
Brian J
BJ
Czerniecki
Rachel R
RR
Kelz
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data*; D044466:Asian People; D044383:Black People; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D044465:White People
Breast cancer; Breast reconstruction; Mastectomy; Outpatient; Racial disparities