Racial Disparities Following Reconstructive Flap Procedures

Abstract

Background: Prior reports have highlighted disparities in healthcare access, environmental conditions, and food insecurity between Black and White populations in the United States. However, limited studies have explored racial disparities in postoperative complications, particularly reconstructive flap surgeries. Methods: Cases of flap reconstruction based on named vascular pedicles were identified in the American College of Surgeons National Surgical Quality Improvement Program database and grouped into 3 time periods: 2005 to 2009, 2010 to 2014, and 2015 to 2019. Logistic regression was used to compare rates of postoperative complications between White and Black patients within each time period while controlling for comorbidities. Data for flap failure was only available from 2005 to 2010. Results: A total of 56,116 patients were included in the study, and 6293 (11.2%) were Black. Black patients were significantly younger than White patients and had increased rates of hypertension, smoking, and diabetes across all years (P<0.01). Black patients had significantly higher rates of sepsis compared to White patients in all time periods. From 2005 to 2009, Black patients had a significantly higher incidence of flap failure (aOR=2.58, P<0.01), return to the operating room (aOR=1.53, P=0.01), and having any complication (aOR=1.48, P<0.01). From 2010 to 2019, White patients had a higher incidence of superficial surgical site infection. Conclusions: Surgical complication rates following flap reconstruction based on a named vascular pedicle were higher for Black patients. Limited data on this topic currently exists, indicating that additional research on the drivers of racial disparities is warranted to improve plastic surgery outcomes in Black patients.