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Utilization Of Healthcare Resources In Lymphatic Anomalies Patients: An Assessment Of Healthcare Burden
Emma Iaconetti, BA1, Shannon Brackett, DNP2, Albert Truong, MD2, Erica M. Fallon, MD3, Sheryl Tulin-Silver, MD4, Maria C. Garzon, MD5, June K. Wu, MD2.
1Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA, 2Columbia University Irving Medical Center Department of Surgery, Division of Plastic and Reconstructive Surgery, New York, NY, USA, 3Columbia University Irving Medical Center Department of Surgery, Division of Pediatric Surgery, New York, NY, USA, 4Columbia University Irving Medical Center Department of Radiology, New York, NY, USA, 5Columbia University Irving Medical Center Department of Dermatology, Division of Pediatric Dermatology, New York, NY, USA.

Purpose: Lymphatic anomalies (LAs) are congenital disorders of the lymphatic system; affected individuals often require life-long inter-disciplinary care. Due to the paucity of data on the healthcare utilization of these patients, the burden on the healthcare system is unquantified. We hypothesize that complex LAs will utilize significantly higher healthcare resources compared to simple LAs.
Methods: A retrospective, longitudinal study was performed of LA patients seen at one hospital system between 1/1/2019-12/31/2020. Data was collected on healthcare utilization from each patient’s first presentation or initial diagnosis, including office visits, number of hospitalizations and hospital days, average lengths of stay (LOS), imaging studies, procedures, and specialists involved and normalized to per year utilization. Using publicly available national averages, approximate costs incurred for each patient in one healthcare system were calculated and normalized to per year utilization. Patients were divided into "simple" and "complex" LAs. Involvement of airway and/or >1 anatomic area was defined as "complex". Additionally, patients with Klippel-Trenaunay syndrome (KTS) were assessed as part of the "complex" group and as their own sub-group. Statistical analysis was performed with Welch’s t-test.
Results: Preliminary analysis of the first 26 patients (16 female, 10 male; median age of 6 years) included 11 simple, 11 complex, and 4 KTS cases. When compared to simple LAs, the combined complex LA and KTS group had significantly higher numbers in all measured metrics (office visits, number of hospitalizations, hospital days, average LOS, imaging studies, procedures, and number of specialists involved). When KTS was removed, the complex LAs were still significantly higher in all metrics except office visits (p=0.069, Figure 1). Further, complex cases incurred significantly higher costs/year with relative costs 12 times higher (p=0.007, Figure 2).
Conclusions: This is a preliminary study with a limited cohort. This data demonstrates that LM care is chronic and costly, especially for complex LAs. The overall average cost/year of our cohort (minus costs of procedures) is greater than $23,000/year. Ongoing review of additional patients will elucidate further trends in healthcare utilization of LA patients, and allow for opportunities to consolidate and optimize care with potential for decreasing cost and burden on healthcare system.


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