67 Disparities in Regional Anesthesia Block Acceptance for Mastectomy With Reconstruction Surgery in a Standardized Setting

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement41st Annual Miami Breast Cancer Conference® - Abstracts
Volume 38
Issue 4
Pages: 80

Figure. Regional Block Volume and Block Refusal Over Time

Figure. Regional Block Volume and Block Refusal Over Time

Background

Available studies suggest disparities in receipt of regional anesthesia prior to breast reconstruction which presents a barrier to equitable perioperative care and pain management. Our goal was to study the factors associated with block receipt for mastectomy
with immediate tissue expander (TE) reconstruction in a high-volume ambulatory surgery practice with standardized regional anesthesia pathways.

Methods

This institutional review board–approved retrospective chart review included patients who underwent mastectomy with immediate TE reconstruction from 2017 to 2022. A total of 4213 patients who underwent mastectomy with immediate TE reconstruction were included. All eligible patients were offered preoperative nerve blocks as part of the clinical regional anesthesia pathway. Patients who declined a block were compared with those who opted for the procedure.

Results

Of all eligible patients who were offered preoperative nerve blocks, 91% accepted, and 9% declined the procedure. Univariate analyses revealed that patients with the lowest rate of block refusal were White, non-Hispanic, English speaking, with commercial insurance, and undergoing bilateral reconstruction. Over time, the rate of block refusal decreased from 12% in 2017 to 6% in 2022. Multivariable logistic regression identified the following variables which reduced the odds of receiving a block: older age (P = .011), Hispanic vs non-Hispanic ethnicity (P = .049), Medicaid vs commercial insurance (P < .001), unilateral vs bilateral surgery (P = .045), and reconstruction in earlier study years vs 2022 (2017, P < .001; 2018, P < .001; 2019, P = .001; 2020, P = .006).

Conclusions

In a standardized, preoperative regional anesthesia program with blocks offered to all clinically appropriate patients undergoing mastectomy, we found an overall low rate of block refusal and no difference in block acceptance based on race. Remaining differences in age, ethnicity, and insurance status suggest that further educational efforts are needed to address patient hesitancies in these populations.

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48 The Era ‘or Error’ of Second Localization Procedures
49 The Influence of Race on Complications in Breast Conservation Surgery: A Single Institution Study
49 The Influence of Race on Complications in Breast Conservation Surgery: A Single Institution Study
51 Ductal Carcinoma In Situ With Microinvasion on Biopsy—What Are the Predictors of Upstaging?
51 Ductal Carcinoma In Situ With Microinvasion on Biopsy—What Are the Predictors of Upstaging?
52 UK Experience of Non-Radioisotope, Non-Magnetic Guided Breast Wide Local Excision and Sentinel Node Biopsy
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53 The Utility of Sentinel Lymph Node Biopsy in High-Grade Ductal Carcinoma In Situ
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54 The Evaluation of Expression Levels of CXCR4, CXCL12, and LASP1 Genes in Peripheral Blood Samples of Breast Cancer Patients
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55 Language as a Barrier to Deep Inspiration Breath Hold (DIBH) Radiation Therapy for Left  Breast Cancer
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56 Predictive Factors Correlating With Pathologic Complete Response Rates in Racially Diverse, Minority Populations Receiving Neoadjuvant Therapy for HR+/HER2– Breast Cancer
56 Predictive Factors Correlating With Pathologic Complete Response Rates in Racially Diverse, Minority Populations Receiving Neoadjuvant Therapy for HR+/HER2– Breast Cancer
57 Addressing Barriers to Identifying Patients With HER2-Low Metastatic Breast Cancer in a Large Community Oncology Practice
57 Addressing Barriers to Identifying Patients With HER2-Low Metastatic Breast Cancer in a Large Community Oncology Practice
58 Prospective Longitudinal Assessment of Financial Toxicity Among Breast Cancer Patients
58 Prospective Longitudinal Assessment of Financial Toxicity Among Breast Cancer Patients
59 Acceptability of Microbiome Sampling-Based Surgical Oncology Research in Minority Breast Cancer Patients
59 Acceptability of Microbiome Sampling-Based Surgical Oncology Research in Minority Breast Cancer Patients
60 Racial Disparities in Hospitalization Outcomes Among Women With Metastatic Breast  Cancer in the United States by Palliative Care Utilization
60 Racial Disparities in Hospitalization Outcomes Among Women With Metastatic Breast Cancer in the United States by Palliative Care Utilization
61 High-Risk Screening Compliance in Women Diagnosed With Breast Cancer and a History of Thoracic Radiation Prior to Age 30
61 High-Risk Screening Compliance in Women Diagnosed With Breast Cancer and a History of Thoracic Radiation Prior to Age 30
62 The Impact of Genomic Assays on Breast Cancer Systemic Therapy Treatment Decisions in a Mostly Black Patient Population
62 The Impact of Genomic Assays on Breast Cancer Systemic Therapy Treatment Decisions in a Mostly Black Patient Population
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