Background
The Plastic and Reconstructive Surgery department at Counties Manukau District Health Board (CMDHB) provides tertiary-level access to post mastectomy breast reconstruction (PMBR) for all patients in the Northern Region Alliance (NRA). Education around PMBR availability and time commitment required may be beneficial for patients and referring clinicians. Access to PMBR is not always equitable. CMDHB is committed to achieve equity in key health indicators and access in Maori and Pacific. We aim to assess equity of access to, and delivery of, PMBR at CMDHB.
Methods
A retrospective review of patients referred to CMDHB for PMBR between January 2013 and June 2018 was performed. Demographic information was compared to expected population figures from NRA data. Methods of reconstruction were assessed for differences in operative duration, number of operations/clinic visits, and length of stay.
Results
Significant discrepancies in ethnicity and DHB of domicile were found between expected population proportions and the patients referred for PMBR. European and Maori patients were proportionally represented in the cohort, whereas Asian and Pacific Peoples were under-represented (p=0.0016). Within the referral cohort, Maori and Asians were less likely to be proceed to PMBR following specialist assessment than European patients (p=0.0015 and 0.0193 respectively). Northland DHB and Waitemata DHB were under-represented in number of PMBR referrals, while Auckland DHB and CMDHB refer an appropriately represented number of patients (p=0.0022). PMBR method preferences has evolved, with the number of free flap autologous reconstructions increasing while the number of expander implant reconstructions are decreasing (p=0.0006).
Conclusion
There is inequity in rates of tertiary referral for PMBR across ethnicities and DHBs in the NRA, which is likely multifactorial. Further research is required to investigate reasons behind this disparity and interventions to achieve equity. The trend in method of PMBR performed can help to optimise resource allocation and health literacy.