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Differences in the Reporting of Racial and Socioeconomic Disparities among Three Large National Databases for Breast Reconstruction

Kamali, Parisa M.D.; Zettervall, Sara L. M.D., M.P.H.; Wu, Winona B.Sc.; Ibrahim, Ahmed M. S. M.D., Ph.D.; Medin, Caroline B.Sc.; Rakhorst, Hinne A. M.D., Ph.D.; Schermerhorn, Marc L. M.D.; Lee, Bernard T. M.D., M.P.H., M.B.A.; Lin, Samuel J. M.D., M.B.A.

Plastic & Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 795–807
doi: 10.1097/PRS.0000000000003207
Breast: Original Articles
Press Release
Video Discussion

Background: Research derived from large-volume databases plays an increasing role in the development of clinical guidelines and health policy. In breast cancer research, the Surveillance, Epidemiology and End Results, National Surgical Quality Improvement Program, and Nationwide Inpatient Sample databases are widely used. This study aims to compare the trends in immediate breast reconstruction and identify the drawbacks and benefits of each database.

Methods: Patients with invasive breast cancer and ductal carcinoma in situ were identified from each database (2005–2012). Trends of immediate breast reconstruction over time were evaluated. Patient demographics and comorbidities were compared. Subgroup analysis of immediate breast reconstruction use per race was conducted.

Results: Within the three databases, 1.2 million patients were studied. Immediate breast reconstruction in invasive breast cancer patients increased significantly over time in all databases. A similar significant upward trend was seen in ductal carcinoma in situ patients. Significant differences in immediate breast reconstruction rates were seen among races; and the disparity differed among the three databases. Rates of comorbidities were similar among the three databases.

Conclusions: There has been a significant increase in immediate breast reconstruction; however, the extent of the reporting of overall immediate breast reconstruction rates and of racial disparities differs significantly among databases. The Nationwide Inpatient Sample and the National Surgical Quality Improvement Program report similar findings, with the Surveillance, Epidemiology and End Results database reporting results significantly lower in several categories. These findings suggest that use of the Surveillance, Epidemiology and End Results database may not be universally generalizable to the entire U.S. population.

Video Discussion By Amy Alderman, M.D., is Available Online for this Article.

Boston, Mass.; Washington, D.C.; New Orleans, La.; and Enschede, The Netherlands

From the Divisions of Plastic and Reconstructive Surgery and Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; George Washington University Medical Center; the Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center; and the Division of Plastic, Reconstructive and Hand Surgery, Medisch Spectrum Twente.

Received for publication May 18, 2016; accepted September 7, 2016.

Disclosure: Dr. Schermerhorn receives consulting fees from Endologix. None of the other authors has a conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (

A Video Discussion by Amy Alderman, M.D., accompanies this article. Go to and click on “Video Discussions” in the “Videos” tab to watch.

Samuel J. Lin, M.D., M.B.A., 110 Francis Street, Suite 5A, Boston, Mass. 02215,

©2017American Society of Plastic Surgeons