Economic impact of bleeding complications after mastectomy.
BACKGROUND
We sought to determine the incidence of postmastectomy bleeding, identify bleeding predictors, and evaluate the economic impact.


METHODS
Using the 2011 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, hospital discharges for a primary diagnosis of breast cancer were extracted using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes 85.34-85.48 for mastectomy and diagnosis codes 174.0-174.9 for breast cancer. Discharges with postoperative bleeding were identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes 998.11 and 998.12. Discharges with male gender or a history of coagulation disorders were excluded. Bleeding complication rates and reoperation rates were assessed. Predictors and the impact of bleeding on length of stay and hospital costs were determined using regression analysis and projected to the national level.


RESULTS
A total of 7907 discharges met inclusion criteria; 201 had bleeding complications (2.54%), with 42 cases requiring reoperation. On univariate analysis, the presence of congestive heart failure (CHF), obesity, diabetes, chronic pulmonary disease, and the absence of concomitant reconstruction were associated with increased bleeding events. On multivariate analysis, only the presence of CHF remained as a significant predictor of bleeding complications (odds ratio [95% confidence interval], 2.45, [1.25-4.92], P = 0.009). On average, bleeding complications extended the length of stay by 1.3 d (P < 0.0001) while increasing hospital costs by $5495 per admission (P < 0.0001). Projected to a national level, bleeding complications accounted for an additional 1254 d of hospital care at a cost exceeding $5.3 million.


CONCLUSIONS
Postmastectomy bleeding complications had an incidence of 2.54%, with CHF the only independent predictor identified. Such bleeding events, although infrequent, are associated with substantial economic costs.
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Iheoma Y
IY
Nwaogu
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Kerry
K
Bommarito
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Margaret A
MA
Olsen
The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri. Electronic address: margenthalerj@wudosis.wustl.edu.
Julie A
JA
Margenthaler
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008408:Mastectomy; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation / Q000191:economics / Q000706:statistics & numerical data; D012307:Risk Factors; D014481:United States
Bleeding; Complication; Healthcare Utilization; Mastectomy; Predictors