Risk Factors Associated with Post-Mastectomy Breast Cancer Lymphedema- A Multicenter Retrospective Analysis
Annet S. Kuruvilla BS, Aleksandra Krajewski MD, Xiaoning Li PhD, Jie Yang PhD, Sagar R. Mulay MD, Sohaib M. Agha BS, Harmehar K. Kohli BA, Raymond M. Bellis BS, Henry J. Tannous MD, A. Laurie W. Shroyer PhD.
Stony Brook University, Renaissance School of Medicine, Stony Brook, New York
Background: Lymphedema is an edematous condition that afflicts many post-surgical cancer patients, especially the post-mastectomy breast cancer population. This burdensome condition may lead to diminished quality of life with substantial health care utilization and corresponding high healthcare costs. The factors predictive of post-mastectomy lymphedema development in breast cancer patients are not well known. For these patients, this study evaluated the trends over time in lymphedema development and the risk factors predictive of lymphedema-related events within 2 years of mastectomy.
Methods: Using the New York Statewide Planning and Research Cooperative System (SPARCS) multicenter de-identified database from 2010 to 2016, a total of 65,543 breast cancer post-mastectomy females (mean age = 59 ± 20 years) were identified across 177 facilities. Among this patient population, breast cancer patients were followed for any two-year post-mastectomy lymphedema-related events. A multivariable model was utilized to identify predictors of two-year lymphedema using eligible variables involving demographics, comorbidities, and complications. Elixhauser score was defined as a comorbidity index based on ICD diagnosis codes used in hospital settings.
Results: Overall, 5.2% (n=3,409) of the breast cancer post-mastectomy patients experienced a lymphedema-related event within two years of initial surgery. Over time, 2-year post-mastectomy lymphedema rates rose significantly by 60%, from 4.09% in 2010 to 6.56% in 2016 (P < 0.001). Two-year post-mastectomy lymphedema rates varied significantly by mastectomy procedure type: 4.66% of the mastectomy-only procedures, 4.87% of the mastectomies with lymph node biopsies, and 6.91% of the mastectomies with lymph node dissections (P < 0.0001). Full mastectomies had a greater 2-year lymphedema rate of 7.31% when compared to partial mastectomies with 2.79% (P < 0.0001). The top predictive risk factors leading to a lymphedema related event included: higher Elixhauser score, prolonged hospitalization for mastectomy, more recent mastectomy procedure, obesity, younger age, non-Asian race, Medicaid insurance, and hypertension (all P < 0.01).
Conclusions: From 2010 – 2016, a 60% increase in the 2-year post-mastectomy lymphedema rates was observed, raising a clinical call to arms. Furthermore, risk factors were identified that predispose post-mastectomy breast cancer females to developing lymphedema. Given these findings, broad-based pre-discharge screening appears warranted to proactively identify, educate, and monitor post-mastectomy patients at greatest risk of future lymphedema development.
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