Abstract P1-11-04: Looking beyond the margins: Economic costs and complications associated with repeated breast-conserving surgeries
Authors: Metcalf LN , Zysk AM , Underwood HR , Edelman G , Vu L , Cittadine AJ , Hyer KB , Thompson AM 
Published: March 2017

Abstract
Background: Although considerable attention has been drawn to the problem of repeat breast-conserving surgery (BCS), the costs and complications due to these additional operations are not well-characterized. In this work, a retrospective review of insurance claims data for BCS patients was performed to assess complications and economic outcomes.
Methods: Private claims data were analyzed for 9,837 women undergoing BCS for breast carcinoma between January 2010 and December 2013. Patients enrolled in insurance plans in IL, TX, NM, and OK were included. Patients undergoing a second open breast surgery (mastectomy or BCS) within 90 days of the initial BCS were classified as having a repeat surgery. Complications were identified via a set of 8 CPT and 25 ICD9 diagnosis and procedure codes related to breast cancer treatment. The analysis included these complications and the total cost of all allowed healthcare claims within two years following diagnosis.
Results: 7,555/9,837 patients (77% ±0.8%, 95% confidence interval) had one BCS operation, and 2,282 patients (23% ±0.8%) had at least one repeat surgery. The mean patient age was 53 years. Women who underwent an additional operation waited an average of 24 days for the procedure.
The mean two-year total costs for patients undergoing a single BCS was $89,016 (±$1,884), and the cost for patients undergoing a repeat breast surgery was $105,088 (±$3,680; p &lt; 0.0001), $100,637 (±$4,219) for a second BCS and $115,292 (±$7,259) for subsequent mastectomy. The mean added cost due to a repeat surgery was $16,072.
The percentage of patients experiencing at least one complication was 23.6% (±1.0%) for those undergoing one BCS only and 34.8% (±2.0%) for those undergoing a repeat operation (p &lt; 0.0001). Patients undergoing repeated surgery were 88% more likely to experience multiple complications (5.5% ±0.5% vs. 10.4% ±1.3%) and nearly three times as likely to experience fat necrosis (2.5% ±0.4% vs. 7.2% ±1.1%). Infection, hematoma/seroma, and breast pain were the most common complications for patients who did not undergo a repeated surgery (9.9% ±0.7%, 8.7% ±0.6%, 6.9% ±0.6%). For patients undergoing a repeated surgery, infection, hematoma/seroma, and fat necrosis were the most common complications (15.3% ±1.5%, 13.9% ±1.4%, 7.2% ±1.1%).
Conclusions: For the 23% of women undergoing a second operation after BCS, complications were 48% more common, and the mean total cost of surgery was $16,072 more, demonstrating statistically-significant evidence of a patient-centered and fiscal imperative to reduce reoperations in BCS for breast cancer.Background: Although considerable attention has been drawn to the problem of repeat breast-conserving surgery (BCS), the costs and complications due to these additional operations are not well-characterized. In this work, a retrospective review of insurance claims data for BCS patients was performed to assess complications and economic outcomes.
Methods: Private claims data were analyzed for 9,837 women undergoing BCS for breast carcinoma between January 2010 and December 2013. Patients enrolled in insurance plans in IL, TX, NM, and OK were included. Patients undergoing a second open breast surgery (mastectomy or BCS) within 90 days of the initial BCS were classified as having a repeat surgery. Complications were identified via a set of 8 CPT and 25 ICD9 diagnosis and procedure codes related to breast cancer treatment. The analysis included these complications and the total cost of all allowed healthcare claims within two years following diagnosis.
Results: 7,555/9,837 patients (77% ±0.8%, 95% confidence interval) had one BCS operation, and 2,282 patients (23% ±0.8%) had at least one repeat surgery. The mean patient age was 53 years. Women who underwent an additional operation waited an average of 24 days for the procedure.
The mean two-year total costs for patients undergoing a single BCS was $89,016 (±$1,884), and the cost for patients undergoing a repeat breast surgery was $105,088 (±$3,680; p &lt; 0.0001), $100,637 (±$4,219) for a second BCS and $115,292 (±$7,259) for subsequent mastectomy. The mean added cost due to a repeat surgery was $16,072.
The percentage of patients experiencing at least one complication was 23.6% (±1.0%) for those undergoing one BCS only and 34.8% (±2.0%) for those undergoing a repeat operation (p &lt; 0.0001). Patients undergoing repeated surgery were 88% more likely to experience multiple complications (5.5% ±0.5% vs. 10.4% ±1.3%) and nearly three times as likely to experience fat necrosis (2.5% ±0.4% vs. 7.2% ±1.1%). Infection, hematoma/seroma, and breast pain were the most common complications for patients who did not undergo a repeated surgery (9.9% ±0.7%, 8.7% ±0.6%, 6.9% ±0.6%). For patients undergoing a repeated surgery, infection, hematoma/seroma, and fat necrosis were the most common complications (15.3% ±1.5%, 13.9% ±1.4%, 7.2% ±1.1%).
The impact of repeated breast-conserving surgeries BCS, No RepeatRepeat BCSConvert to MastectomyPatients76.8% (7,555)16.2% (1,589)7.0% (693)Mean Two-Year Cost Per Patient$89,016$100,637$115,292Patients with any Complication(s)23.6% (1,783)32.5% (516)40.3% (279)Patients with Infection9.9% (746)14.0% (222)18.3% (127)Patients with Hematoma/Seroma8.7% (655)12.8% (203)16.6% (115)Patients with Breast Pain6.9% (525)7.0% (111)6.1% (42)Patients with Fat Necrosis2.5% (187)7.6% (120)6.5% (45)
Conclusions: For the 23% of women undergoing a second operation after BCS, complications were 48% more common, and the mean total cost of surgery was $16,072 more, demonstrating statistically-significant evidence of a patient-centered and fiscal imperative to reduce reoperations in BCS for breast cancer.
Citation Format: Metcalf LN, Zysk AM, Underwood HR, Edelman G, Vu L, Cittadine AJ, Hyer KB, Thompson AM. Looking beyond the margins: Economic costs and complications associated with repeated breast-conserving surgeries [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-11-04.