I. Nwaogu1, M. Olsen1, J. A. Margenthaler1 1Washington University,Surgery,St. Louis, MO, USA
Introduction: Bleeding complications are serious complications following breast cancer surgery but very few single-institution studies have estimated and reported the incidence. Additionally, no studies have examined the economic impact of postoperative bleeding. The present study aims to determine the incidence of bleeding events following mastectomy, identify potential risk factors for bleeding, and evaluate the impact on hospital utilization and treatment costs.
Methods: Using the 2011 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS), mastectomy hospital discharges for a primary diagnosis of breast cancer were extracted using ICD-9-CM procedure codes 85.34-85.48 for mastectomy and diagnosis codes 174.0-174.9 for breast cancer. Discharges with postoperative bleeding were identified based on ICD-9-CM diagnosis codes 998.11 and 998.12. Discharges with male gender or a history of coagulation disorders were excluded from the study. Overall bleeding complication rates and re-operation rates (for bleeding) were assessed. Risk factors and the impact of bleeding on length of stay and hospital costs were determined using regression analysis. The results were projected to the national level.
Results:7907 discharges coded for mastectomy met inclusion criteria. Of these, 201 had bleeding complications (2.54%), with 42 cases requiring re-operation during the mastectomy admission. On univariate analysis, the presence of congestive heart failure (CHF), obesity, diabetes, chronic pulmonary disease, and the absence of concomitant reconstructive surgery were associated with increased bleeding event. On multivariate analysis, only the presence of CHF remained as a statistically significant predictor of bleeding complications (Odds ratio [95% CI]: 2.45, [1.25, 4.92], p = 0.009). On average, bleeding complications extended the length of stay by 1.3 days (p < 0.0001) while increasing hospital costs by $5,495 per admission (p <0.0001). Projected to the national level, bleeding complications accounted for an additional 1,254 days of hospital stay with costs exceeding $5.3 million.
Conclusion:Bleeding complications following mastectomy for breast cancer had an incidence of 2.5%, with CHF the only identified risk factor for bleeding complications. Finally, such bleeding events, although infrequent, are associated with substantial economic costs in terms of extended length of stay and increased treatment costs.