title: Racial and age disparities persist in immediate breast reconstruction: an updated analysis of 48,564 patients from the 2005 to 2011 American College of Surgeons National Surgery Quality Improvement Program data sets.
abstract: BACKGROUND
  Immediate breast reconstruction (IBR) rates continue to rise, yet recent patterns based on race, age, and patient comorbidities have not been adequately assessed.
  
  
  METHODS
  Women undergoing mastectomy only or mastectomy with IBR from 2005 to 2011 were identified in the American College of Surgeons-National Surgical Quality Improvement (NSQIP) data sets. A multivariate logistic regression was performed to determine factors independently associated with receipt of IBR. Thirty-day surgical complication rates after IBR were also assessed.
  
  
  RESULTS
  Rates of IBR increased significantly over the study period from 26% of patients in 2005 to 40% in 2011. Non-Caucasian race, older age (≥45 years), obesity, and presence of comorbid conditions including diabetes mellitus, current smoking, and cardiovascular disease were all negatively associated with receipt of IBR. Surgical complication rates after IBR were not predicted by non-Caucasian race, older age, or presence of diabetes mellitus.
  
  
  CONCLUSIONS
  This current assessment of IBR using the American College of Surgeons-National Surgical Quality Improvement data sets demonstrates that non-Caucasian and older women (≥45 years) continue to receive IBR at lower rates despite the lack of association of added risk of surgical morbidity.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, Perelman Center for Advanced Medicine, South Tower, 7th Floor, Philadelphia, PA, 19104, USA. Electronic address: paris.butler@uphs.upenn.edu.
authors.forename: Paris D
authors.initials: PD
authors.lastname: Butler
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, Perelman Center for Advanced Medicine, South Tower, 7th Floor, Philadelphia, PA, 19104, USA.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, Perelman Center for Advanced Medicine, South Tower, 7th Floor, Philadelphia, PA, 19104, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, Perelman Center for Advanced Medicine, South Tower, 7th Floor, Philadelphia, PA, 19104, USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wink
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, Perelman Center for Advanced Medicine, South Tower, 7th Floor, Philadelphia, PA, 19104, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Chang
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, Perelman Center for Advanced Medicine, South Tower, 7th Floor, Philadelphia, PA, 19104, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Fosnot
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, Perelman Center for Advanced Medicine, South Tower, 7th Floor, Philadelphia, PA, 19104, USA.
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, Perelman Center for Advanced Medicine, South Tower, 7th Floor, Philadelphia, PA, 19104, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
mesh_terms: D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods* / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment; D058996:Quality Improvement; D044469:Racial Groups / Q000208:ethnology; D012189:Retrospective Studies; D018570:Risk Assessment; D012955:Societies, Medical; D014481:United States
keywords: Breast Reconstruction; Health care disparity; NSQIP