Hospital Setting Impact on Breast Cancer-Related Lymphedema and Quality-of-Life After Immediate Lymphatic Reconstruction

Abstract

Background: Hospital setting may influence surgical outcomes, but its impact on immediate lymphatic reconstruction (ILR) for preventing breast cancer-related lymphedema (BCRL) after axillary lymph node dissection (ALND) is unknown. This study assesses BCRL incidence and related outcomes following ILR comparing academic and community hospitals within a multi-hospital network. Methods: We retrospectively studied consecutive patients who underwent ILR following ALND between 2017 and 2024 across six hospitals. Hospitals were categorized as academic or community based. The primary outcome, BCRL incidence and secondary outcomes including complications and patient-reported outcomes (LYMPH-Q), were compared using multivariable regression models adjusting for patient and treatment factors. Results: We identified 172 patients with a mean age 50.9±11.6 years, BMI of 29.5±6.9 kg/m², and follow-up time of 23.1±15.2 months. ILR occurred at academic hospitals for 88 patients (51.2%) and community hospitals for 84 patients (48.8%). BCRL incidence was comparable between academic (6.8%) and community (7.1%) settings (p=0.933). In multivariable regression, hospital setting was not significantly associated with the odds of developing BCRL (OR 0.80; p=0.730), surgical complications (OR, 1.21; p=0.642), unplanned reoperation (OR, 1.43; p=0.418) or LYMPH-Q symptoms (β, -11.20; p=0.063), function (β, -4.9; p=0.834), appearance (β, -7.16; p=0.413), or psychological well-being (β, -5.25; p=0.504) scales. Conclusions: ILR demonstrated comparable outcomes for BCRL incidence, complications, and patient-reported quality of life between academic and community settings. These findings suggest ILR can be successfully implemented beyond traditional academic centers with appropriate surgeon expertise and institutional support, potentially improving access to preventative lymphedema surgery.