Women Who Develop Complicated Lymphedema Following Surgical Treatment For Breast Cancer Experience High Rates Of Hospitalization
John P. Fischer, MD, Justin P. Fox, M.D., M.H.S, Marten Basta, B.S., Joshua Fosnot, MD, Joseph M. Serletti, MD, Suhail K. Kanchwala, MD.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: Lymphedema following breast cancer treatment can become a disabling condition necessitating inpatient care. The purpose of this study was to estimate the prevalence of complicated lymphedema following breast cancer surgery; calculate hospital resource utilization in this population; and determine if prevalence is influenced by breast reconstruction.
METHODS: We identified adult women who underwent lumpectomy or mastectomy with an axillary lymph node procedure for cancer between 2007-2009 using five state inpatient databases (AR, CA, FL, NE, and NY). Patients were grouped according to the development of complicated lymphedema. The primary outcomes were all-cause, hospital admissions and associated healthcare charges within 2-years of surgery. Multivariate Poisson and linear regression models were used to compare outcomes.
RESULTS: The final sample included 37,621 women with 1,202 (3.2%) having at least one hospital admission for complicated lymphedema within 2-years of surgery. Despite adjusting for competing conditions, women with complicated lymphedema had nearly 4-fold more all-cause (incidence rate ratio (IRR)=3.85, 95% CI [3.67-4.04]) and 2-fold more (IRR=2.09, 1.93-2.26) non-lymphedema hospital admissions compared to women without complicated lymphedema. This high rate of hospitalization resulted in substantially higher healthcare charges. While women undergoing complete axillary dissection and select medical conditions were more likely to develop complicated lymphedema, immediate breast reconstruction appeared unrelated.
CONCLUSION: Complicated lymphedema develops in a measurable number of women undergoing surgery for breast cancer resulting in high healthcare utilization.
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