Summary
Introduction
Melanoma occurs most commonly in non-Hispanic White patients; however, Black and Hispanic
patients experience greater morbidity and mortality. This study assesses how race
and socioeconomic factors influence rates of reconstructive procedures and hospital-based
outcomes in melanoma patients.
Methods
Data were extracted from the National Inpatient Sample database from the years 2010–2015.
Patients with melanoma who underwent a reconstructive procedure were identified. Univariate
and multivariate logistic regression analysis was used to identify the relationship
between dependent variables and various patient/hospital components for patients undergoing
reconstructive procedures.
Results
Black and Hispanic patients had a greater length of stay (LOS) than non-Hispanic White
patients (OR: 2.252, p = 0.0307, and OR: 2.592, p = 0.0014), and Hispanic patients were less likely to receive more complex reconstructive
procedures (OR: 0.449, p = 0.0487). Patients living in rural areas were less likely to receive complex reconstructive
procedures than those in both urban teaching and non-teaching hospitals (OR: 3.313,
p = 0.0135, and OR: 3.505, p = 0.0074). Pedicled or rotational flaps were less likely to be performed at medium-
or large-sized hospitals (OR: 0.610, p = 0.0296, and OR: 0.496, p = 0.0002).
Conclusion
Race and socioeconomic factors are important predictors of access to complex reconstructive
procedures and hospital-based outcomes following extirpation in melanoma patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- SEER Cancer Statistics review, 1975-2017.National Cancer Institute, Bethesda, MD2020 ([cited 2021 June 15]. Available from:)
- Cancer Statistics, 2021.CA Cancer J Clin. 2021; 71: 7-33
- Skin cancer risk perceptions: a comparison across ethnicity, age, education, gender, and income.J Am Acad Dermatol. 2012; 66: 771-779
- Racial disparities in melanoma survival.J Am Acad Dermatol. 2016; 75: 983-991
- Social determinants of racial and ethnic disparities in cutaneous melanoma outcomes.Cancer Control. 2014; 21: 343-349
- Racial differences in survival after surgical treatment for melanoma.Ann Surg Oncol. 2011; 18: 2925-2936
- Patterns of overall mortality by race/ethnicity and socioeconomic status in insured cancer patients in Southern California.Cancer Causes Control. 2021; 32: 609-616
- The ongoing racial disparities in melanoma: an analysis of the Surveillance, Epidemiology, and End Results database (1975-2016).J Am Acad Dermatol. 2021; 84: 1585-1593
- New systematic therapies and trends in cutaneous melanoma deaths among US Whites, 1986-2016.Am J Public Health. 2020; 110: 731-733
- Distance to diagnosing provider as a measure of access for patients with melanoma.Arch Dermatol. 2007; 143: 991-998
- A look at racial and socioeconomic disparities in post-mastectomy breast reconstruction at a midwestern academic hospital.Breast J. 2021; 27: 461-465
- Racial disparities in postmastectomy breast reconstruction: national trends in utilization from 2005 to 2014.Cancer. 2018; 124: 2774-2784
- National trends and predictors of mastectomy with immediate breast reconstruction.Am J Surg. 2021;
- Racial differences in time to treatment for melanoma.J Am Acad Dermatol. 2020; 83: 854-859
- Racial Disparities in the Use of Surgical Procedures in the US.JAMA Surg. 2021; 156: 274-281
- Are patients of low socioeconomic status receiving suboptimal management for pancreatic adenocarcinoma?.Cancer. 2010; 116: 723-733
- Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors.J Am Coll Surg. 2013; 216 (482-92 e12)
- Disparities in rates of surgical intervention among racial and ethnic minorities in medicare accountable care organizations.Ann Surg. 2019; 269: 459-464
- Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients.N Engl J Med. 2003; 349: 1350-1359
- Consensus of free flap complications: using a nomenclature paradigm in microvascular head and neck reconstruction.Head Neck. 2021;
- Skin cancer in skin of color.Dermatol Nurs. 2009; 21 (206; quiz 178): 170-177
Program NCRHR. Rural Health Snapshot (2017) Chapel Hill, NC: Cecil G. Sheps Center for Health Services Research; 2017 [cited 2021 June 15]. Available from: https://www.shepscenter.unc.edu/product/rural-health-snapshot-2017/.
- General surgery graduates may be ill prepared to enter rural or community surgical practice.Am J Surg. 2013; 205: 752-757
- Rural hospital inpatient surgical volume: cutting-edge service or operating on the margin?.J Rural Health. 1994; 10: 16-25
- Characteristics of practice among rural and urban general surgeons in North Carolina.Ann Surg. 2009; 249: 1052-1060
- Is there a role for the small rural hospital?.J Rural Health. 1990; 6: 101-118
- Medicaid beneficiaries undergoing complex surgery at quality care centers: insights into the Affordable Care Act.Am J Surg. 2016; 211: 750-754
- Insurance and inpatient care: differences in length of stay and costs between surgically treated cancer patients.Cancer. 2012; 118: 5084-5091
- Hospitalization outcomes and racial disparities in cervical cancer patients: an analysis of the national inpatient sample data from 2002 to 2014.Cancer Epidemiol. 2019; 63101620
- African Americans and their distrust of the health care system: healthcare for diverse populations.J Cult Divers. 2007; 14: 56-60
Foundation R.W.J. Discrimination in America: experiences and views of African Americans 2017 [cited 2021 June 15]. Available from: https://www.rwjf.org/en/library/research/2017/10/discrimination-in-america–experiences-and-views.html
- Patterns of cancer screening in primary care from 2005 to 2010.Cancer. 2014; 120: 253-261
- Acral melanoma: considerations about the surgical management of this tumor.An Bras Dermatol. 2019; 94 (Epub 2019 Sep 30. PMID: 31777374; PMCID: PMC6857676): 632-633https://doi.org/10.1016/j.abd.2019.09.019
- Reconstruction of defects in the weight-bearing plantar area using the innervated free medial plantar (Instep) flap.Ann Plast Surg. 2018; 80 (PMID: 29406384): 245-251https://doi.org/10.1097/SAP.0000000000001274
- Reconstruction of the heel, middle foot sole, and plantar forefoot with the medial plantar artery perforator flap: clinical experience with 28 cases.Plast Reconstr Surg. 2018; 141 (PMID: 28938363): 200-208https://doi.org/10.1097/PRS.0000000000003975
- Functional outcomes after heel pad reconstruction: a review of 7 cases.J Foot Ankle Surgery. 2017; 56: 1114-1120
Laura G-R, Ana De J, Arturo V, Belén M, Pablo B. Weight-bearing Plantar Reconstruction Using a Propeller Flap from the Lateral Plantar Artery Perforators, Plast Reconstr Surg Glob Open 2021;9(1) p e3345. doi:10.1097/GOX.0000000000003345.
- Split-thickness skin grafts. [Updated 2022 May 8].StatPearls [Internet]. StatPearls Publishing, Treasure Island (FL)2022
- Physician racial bias and word use during racially discordant medical interactions.Health Commun. 2017; 32: 401-408https://doi.org/10.1080/10410236.2016.1138389
- Chronic noncancer pain management and systemic racism: time to move toward equal care standards.J Pain Res. 2020; 13 (PMID: 33192090; PMCID: PMC7654542): 2825-2836https://doi.org/10.2147/JPR.S287314
- Overall survival in patients with metastatic melanoma.Curr Med Res Opin. 2015; 31 (Epub 2015 Mar 18. PMID: 25708472): 987-991https://doi.org/10.1185/03007995.2015.1021904
Article info
Publication history
Published online: August 21, 2022
Accepted:
August 16,
2022
Received:
August 25,
2021
Footnotes
Data Availability Statement: The data that support the findings of this study are openly available in the National Inpatient Sample database at https://www.hcup-us.ahrq.gov/.
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
