Marten N Basta1, Justin P Fox1, Suhail K Kanchwala1, Liza C Wu1, Joseph M Serletti1, Stephen J Kovach1, Joshua Fosnot1, John P Fischer2. 1. Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, 10 Penn Tower, 3400 Civic Center Blvd., Philadelphia, PA 19103. 2. Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, 10 Penn Tower, 3400 Civic Center Blvd., Philadelphia, PA 19103. Electronic address: john.fischer2@uphs.upenn.edu.
Abstract
BACKGROUND: Lymphedema can become a disabling condition necessitating inpatient care. This study aimed to estimate complicated lymphedema incidence after breast cancer surgery and calculate associated hospital resource utilization. METHODS: We identified adult women undergoing lumpectomy and/or mastectomy with axillary lymph node surgery between 2006 and 2012 using 5-state inpatient databases. Patients were grouped according to the development of complicated lymphedema. The primary outcomes were all-cause hospitalizations and health care charges within 2 years of surgery. Multivariate regression models were used to compare outcomes. RESULTS: Of 56,075 women included, 2.3% had at least 1 hospital admission for complicated lymphedema within 2 years of surgery. Despite confounder adjustment, women with complicated lymphedema experienced 5 fold more all-cause (incidence rate ratio = 5.02, 95% confidence interval: 4.76 to 5.29) admissions compared with women without lymphedema. This resulted in substantially higher health care charges ($58,088 vs $31,819 per patient, P < .001). Although axillary dissection and certain comorbidities were associated with complicated lymphedema, breast reconstruction appeared unrelated. CONCLUSIONS: Complicated lymphedema develops in a quantifiable number of patients. The health care burden of lymphedema underscored here mandates further investigation into targeted, anticipatory management strategies for breast cancer-related lymphedema.
BACKGROUND:Lymphedema can become a disabling condition necessitating inpatient care. This study aimed to estimate complicated lymphedema incidence after breast cancer surgery and calculate associated hospital resource utilization. METHODS: We identified adult women undergoing lumpectomy and/or mastectomy with axillary lymph node surgery between 2006 and 2012 using 5-state inpatient databases. Patients were grouped according to the development of complicated lymphedema. The primary outcomes were all-cause hospitalizations and health care charges within 2 years of surgery. Multivariate regression models were used to compare outcomes. RESULTS: Of 56,075 women included, 2.3% had at least 1 hospital admission for complicated lymphedema within 2 years of surgery. Despite confounder adjustment, women with complicated lymphedema experienced 5 fold more all-cause (incidence rate ratio = 5.02, 95% confidence interval: 4.76 to 5.29) admissions compared with women without lymphedema. This resulted in substantially higher health care charges ($58,088 vs $31,819 per patient, P < .001). Although axillary dissection and certain comorbidities were associated with complicated lymphedema, breast reconstruction appeared unrelated. CONCLUSIONS: Complicated lymphedema develops in a quantifiable number of patients. The health care burden of lymphedema underscored here mandates further investigation into targeted, anticipatory management strategies for breast cancer-related lymphedema.
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