Two decades of change: Trends and disparities in breast cancer surgical outcomes.

Abstract

e12742 Background: Breast cancer is the most commonly diagnosed malignancy among women in the United States, and surgery remains the cornerstone of treatment. Although advances in surgical care have reduced morbidity and mortality, contemporary analyses of perioperative outcomes are limited, highlighting the need for an updated evaluation. This study aims to examine trends in breast cancer surgical outcomes and associated disparities over the past two decades. Methods: This retrospective, cross-sectional study utilized the National Inpatient Sample database. The study population included females aged ≥18 years with stage I–III breast cancer, who underwent inpatient lumpectomy or mastectomy, with or without breast reconstruction, between 2001 and 2021. Multivariable regression analyses adjusted for patient- and hospital-level confounders to evaluate in-hospital mortality, length of stay (LOS), cost, and postoperative complications. In-hospital mortality following complications was compared across racial groups using chi-squared tests with Non-Hispanic (NH) White patients as the reference group. Results: Among 993,551 patients, in-hospital mortality declined (6.24 to 5.67 per 10,000 patients), while median hospitalization costs increased ($7,379.34 to $23,362.62) over the study period. Most surgical complications rates remained stable; however, reported deep vein thrombosis increased 0.023% per year (Confidence Interval (CI): 0.016–0.030). Private insurance was associated with a lower risk of surgical complications [adjusted Odds Ratio (aOR) = 0.86, (CI: 0.83–0.89)] and in-hospital mortality (aOR = 0.40, CI: 0.27–0.59). NH Black patients had higher odds of in-hospital mortality (aOR = 2.20, CI: 1.69–2.87), longer LOS (RR = 1.12, CI: 1.11–1.12), and higher systemic (aOR = 1.13, CI: 1.09–1.18) and surgical complications (aOR = 1.50, CI: 1.46–1.54); specifically higher rates of postoperative hemorrhage/hematoma (+0.70% - 1.06%). NH Asian American/Pacific Islander (AAPI) patients also demonstrated higher odds of surgical complications [aOR = 1.19 (CI: 1.12–1.24)]. Hispanic patients experienced lower hemorrhage/hematoma complication rates compared with NH White patients across the study period (2001-2010: 1.65% vs 2.33%; 2010-2021: 2.84% vs 3.77%). All results p < 0.001. Yearly trend analyses demonstrated a narrowing disparity in postoperative hemorrhage/hematoma rates for NH Black patients (p = 0.006) and widening disparity among NH AAPI (p = 0.045). Conclusions: Over the past two decades breast cancer surgical outcomes have improved, overall; however, substantial racial/ethnic and socioeconomic disparities persist. Despite narrowing of specific gaps, inequities remain pronounced, emphasizing the importance of targeted, equity-focused interventions to improve postoperative outcomes.