S. Roh1, L. K. Viennas1, D. Chin1, J. N. Collins1, R. C. Britt1, R. R. Perry1, E. C. Feliberti1 1Eastern Virginia Medical School,Surgery,Norfolk, VA, USA
Introduction:
Healthcare disparities exist in various stages of breast cancer treatment among different socioeconomic classes. With increased number of uninsured patients having access and receiving immediate breast reconstruction (IBR) due to the Breast and Cervical Cancer Early Detection Program (Every Woman’s Life), an analysis of IBR in these women was performed to compare perioperative outcomes with insured patients and assess for persistent disparities.
Methods:
A retrospective chart review was performed on a database of newly diagnosed female breast cancer patients that underwent total mastectomy with IBR at an urban academic medical center from January 2009 to June 2014. Patient demographics and oncologic and operative variables including postoperative outcomes were compared in women with and without medical insurance at the time of diagnosis.
Results:
Fifty-nine patients met the study criteria, 40 with insurance and 19 without insurance at the time of diagnosis. Mean age at time of diagnosis was similar in uninsured and insured cohorts (51.2 y.o. vs. 48.3 y.o., p = 0.18) and uninsured patients had a higher makeup of African-American patients (73.7% vs. 40%, p =0.01). There were no differences noted between the two groups in body mass index (33.5 vs. 31.7, p = 0.3), mean Charlson Comorbidity Index (2.6 vs. 1.8, p = 0.11), the percentage of smokers (42.1% vs. 25%, p = 0.22) or the receipt of neoadjuvant chemotherapy (15.8% vs. 25%, p = 0.41) or postmastectomy radiation (26.3% vs. 32.5%, p = 0.77). Uninsured patients exclusively received IBR with tissue expanders compared to insured patients, (100% vs. 85%, p = 0.01). Both overall (84.2% vs. 67.5%, p = 0.22) and major (15.8% vs. 30%, p = 0.6) perioperative complication rates were similar between the 2 cohorts, even in those receiving IBR with tissue expanders (major complication rate 15.8% vs. 25%, p = 0.76).
Conclusion:
IBR in uninsured breast cancer patients was performed safely in this study with similar perioperative risk factors and postoperative complications. The higher use of IBR with tissue expanders in uninsured patients suggests hidden disparities. Further studies should analyze for possible provider level and patient level bias.