title: Complicated breast cancer-related lymphedema: evaluating health care resource utilization and associated costs of management.
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.
authors.affiliation: 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.
authors.forename: Marten N
authors.initials: MN
authors.lastname: Basta
authors.affiliation: 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.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Fox
authors.affiliation: 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.
authors.forename: Suhail K
authors.initials: SK
authors.lastname: Kanchwala
authors.affiliation: 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.
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
authors.affiliation: 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.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
authors.affiliation: 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.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
authors.affiliation: 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.
authors.forename: Joshua
authors.initials: J
authors.lastname: Fosnot
authors.affiliation: 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.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D016015:Logistic Models; D008197:Lymph Node Excision; D008209:Lymphedema / Q000191:economics / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
keywords: Breast cancer; Health care economics; Health care utilization; Lymphedema; Operative complications