90th Annual Meeting Abstracts
Short-term Outcomes Following Surgery for Breast Cancer in Pregnant Women in the U.S.
*SreyRam Kuy, MD1, Sanziana A Roman, MD2, *Rani Desai, PhD3, Julie Ann Sosa, MD, MA4
1Robert Wood Johnson Clinical Scholars Program at Yale University School of Medicine, United States Department of Veterans Affairs, and Department of Surgery at Medical College of Wisconsin, New Haven, CT;2Division of Endocrine Surgery, Department of Surgery at Yale University School of Medicine, New Haven, CT;3Robert Wood Johnson Clinical Scholars Program, Yale School of Epidemiology, Veterans Affairs Connecticut system, New Haven, CT;4Divisions of Endocrine Surgery and Surgical Oncology, Department of Surgery at Yale University School of Medicine, New Haven, CT
Objective: To perform the first population-based measurement of short-term clinical and economic outcomes after surgery for breast cancer in pregnant women.
Design: Retrospective cross-sectional cohort study.
Setting: Health Care Utilization Project-Nationwide Inpatient Sample.
Patients: All pregnant women with breast cancer who underwent lumpectomy or mastectomy were compared to age-restricted non-pregnant women with breast cancer undergoing the same procedures, 1999-2006.
Interventions: Statistics: chi-square, Student’s t-test, ANOVA.
Main Outcome Measures: Complications (surgical, maternal, fetal), in-hospital mortality, mean length of stay (LOS) and cost.
Results: 185 pregnant and 47,985 non-pregnant women with breast cancer underwent breast surgery. Mean age of pregnant vs. non-pregnant women was 35 vs. 45 years, p<.001. Pregnant women were less likely to have carcinoma in situ (13% vs. 21%, p=.001). They were more likely to undergo lumpectomy (28% vs.18%, p<.001), have urgent admissions (18% vs. 12 %, p=.24), private insurance (21% vs. 18%, p=.006) and to be treated at non-teaching hospitals (64% vs. 56%, p=.026). There were no differences between pregnant and non-pregnant women in terms of mortality, surgical complications, LOS, cost, and discharge disposition. Fetal complications among pregnant women included an overall rate of 11.4%, early or threatened labor 6.5%, and fetal loss 5%. Early or threatened labor did not result in fetal loss. Among those who had fetal loss, 78% had an induced abortion, 11% spontaneous abortion, and 11% intrauterine death. Maternal complications included an overall rate of 9.2%, cesarean section 9.0%, and dilation and curettage 0.5%.
Conclusions: Pregnant and non-pregnant women undergoing breast surgery for cancer have similar short-term outcomes, but pregnant women have significant maternal and fetal complications.