Hospitalizations for fracture in patients with metastatic disease

Primary source lesions in the United States

Lucas Nikkel, Bilal Mahmood, Sarah Lander, Michael Maceroli, Edward Fox, Wakenda Tyler, Lauren Karbach, John Elfar

Research output: Contribution to journalArticle

Abstract

Background Breast, lung, thyroid, kidney, and prostate cancers have high rates of metastasis to bone in cadaveric studies. However, bone metastasis at time of death may be less clinically relevant than occurrence of pathologic fracture and related morbidity. No population-based studies have examined the economic burden from pathologic fractures. Objectives To determine primary tumors in patients hospitalized with metastatic disease who sustain pathologic and nonpathologic (traumatic) fractures, and to estimate the costs and lengths of stay for associated hospitalizations in patients with metastatic disease and fracture. Methods The Healthcare Cost and Utilization Project’s National (Nationwide) Inpatient Sample was used to retrospectively identify patients with metastatic disease in the United States who had been hospitalized with pathologic or nonpathologic fracture during from 2003-2010. Patients with pathologic fracture were compared with patients with nonpathologic fractures and those without fractures. Results Of 674,680 hospitalizations of patients with metastatic disease, 17,313 hospitalizations were for pathologic fractures and 12,770 were for nonpathologic fractures. The most common primary cancers in patients hospitalized for fractures were lung (187,059 hospitalizations; 5,652 pathologic fractures; 3% of hospitalizations were for pathologic fractures), breast (124,303; 5,252; 4.2%), prostate (79,052; 2,233; 2.8%), kidney (32,263; 1,765; 5.5%), and colorectal carcinoma (172,039; 940; 0.5%). Kidney cancer had the highest rate of hospitalization for pathologic fracture (24 hospitalizations/1,000 newly diagnosed cases). Patients hospitalized for pathologic fracture had higher billed costs and longer length of stay. Limitations Hospital administrative discharge data includes only billed charges from the inpatient hospitalization. Conclusion Metastatic lung, breast, prostate, kidney, and colorectal carcinoma are commonly seen in patients hospitalized with pathologic fracture. Pathologic fracture is associated with higher costs and longer hospitalization. Funding Grants from the NIH (K08 AR060164-01A), American Society for Surgery of the Hand Hand Surgeon Scientist Award grant, and University of Rochester Medical Center Clinical & Translational Science Institute grants, in addition to institutional support from the University of Rochester and Pennsylvania State University Medical Centers.

Original languageEnglish (US)
Pages (from-to)e14-e20
JournalJournal of Community and Supportive Oncology
Volume16
Issue number1
DOIs
StatePublished - Feb 1 2018

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Spontaneous Fractures
Hospitalization
Organized Financing
Kidney Neoplasms
Costs and Cost Analysis
Inpatients
Prostate
Colorectal Neoplasms
Length of Stay
Breast
Hand
Neoplasm Metastasis
Kidney
Bone and Bones
Lung
Thyroid Neoplasms
Health Care Costs
Lung Neoplasms
Neoplasms
Prostatic Neoplasms

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology

Cite this

Nikkel, Lucas ; Mahmood, Bilal ; Lander, Sarah ; Maceroli, Michael ; Fox, Edward ; Tyler, Wakenda ; Karbach, Lauren ; Elfar, John. / Hospitalizations for fracture in patients with metastatic disease : Primary source lesions in the United States. In: Journal of Community and Supportive Oncology. 2018 ; Vol. 16, No. 1. pp. e14-e20.
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abstract = "Background Breast, lung, thyroid, kidney, and prostate cancers have high rates of metastasis to bone in cadaveric studies. However, bone metastasis at time of death may be less clinically relevant than occurrence of pathologic fracture and related morbidity. No population-based studies have examined the economic burden from pathologic fractures. Objectives To determine primary tumors in patients hospitalized with metastatic disease who sustain pathologic and nonpathologic (traumatic) fractures, and to estimate the costs and lengths of stay for associated hospitalizations in patients with metastatic disease and fracture. Methods The Healthcare Cost and Utilization Project’s National (Nationwide) Inpatient Sample was used to retrospectively identify patients with metastatic disease in the United States who had been hospitalized with pathologic or nonpathologic fracture during from 2003-2010. Patients with pathologic fracture were compared with patients with nonpathologic fractures and those without fractures. Results Of 674,680 hospitalizations of patients with metastatic disease, 17,313 hospitalizations were for pathologic fractures and 12,770 were for nonpathologic fractures. The most common primary cancers in patients hospitalized for fractures were lung (187,059 hospitalizations; 5,652 pathologic fractures; 3{\%} of hospitalizations were for pathologic fractures), breast (124,303; 5,252; 4.2{\%}), prostate (79,052; 2,233; 2.8{\%}), kidney (32,263; 1,765; 5.5{\%}), and colorectal carcinoma (172,039; 940; 0.5{\%}). Kidney cancer had the highest rate of hospitalization for pathologic fracture (24 hospitalizations/1,000 newly diagnosed cases). Patients hospitalized for pathologic fracture had higher billed costs and longer length of stay. Limitations Hospital administrative discharge data includes only billed charges from the inpatient hospitalization. Conclusion Metastatic lung, breast, prostate, kidney, and colorectal carcinoma are commonly seen in patients hospitalized with pathologic fracture. Pathologic fracture is associated with higher costs and longer hospitalization. Funding Grants from the NIH (K08 AR060164-01A), American Society for Surgery of the Hand Hand Surgeon Scientist Award grant, and University of Rochester Medical Center Clinical & Translational Science Institute grants, in addition to institutional support from the University of Rochester and Pennsylvania State University Medical Centers.",
author = "Lucas Nikkel and Bilal Mahmood and Sarah Lander and Michael Maceroli and Edward Fox and Wakenda Tyler and Lauren Karbach and John Elfar",
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Hospitalizations for fracture in patients with metastatic disease : Primary source lesions in the United States. / Nikkel, Lucas; Mahmood, Bilal; Lander, Sarah; Maceroli, Michael; Fox, Edward; Tyler, Wakenda; Karbach, Lauren; Elfar, John.

In: Journal of Community and Supportive Oncology, Vol. 16, No. 1, 01.02.2018, p. e14-e20.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Hospitalizations for fracture in patients with metastatic disease

T2 - Primary source lesions in the United States

AU - Nikkel, Lucas

AU - Mahmood, Bilal

AU - Lander, Sarah

AU - Maceroli, Michael

AU - Fox, Edward

AU - Tyler, Wakenda

AU - Karbach, Lauren

AU - Elfar, John

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background Breast, lung, thyroid, kidney, and prostate cancers have high rates of metastasis to bone in cadaveric studies. However, bone metastasis at time of death may be less clinically relevant than occurrence of pathologic fracture and related morbidity. No population-based studies have examined the economic burden from pathologic fractures. Objectives To determine primary tumors in patients hospitalized with metastatic disease who sustain pathologic and nonpathologic (traumatic) fractures, and to estimate the costs and lengths of stay for associated hospitalizations in patients with metastatic disease and fracture. Methods The Healthcare Cost and Utilization Project’s National (Nationwide) Inpatient Sample was used to retrospectively identify patients with metastatic disease in the United States who had been hospitalized with pathologic or nonpathologic fracture during from 2003-2010. Patients with pathologic fracture were compared with patients with nonpathologic fractures and those without fractures. Results Of 674,680 hospitalizations of patients with metastatic disease, 17,313 hospitalizations were for pathologic fractures and 12,770 were for nonpathologic fractures. The most common primary cancers in patients hospitalized for fractures were lung (187,059 hospitalizations; 5,652 pathologic fractures; 3% of hospitalizations were for pathologic fractures), breast (124,303; 5,252; 4.2%), prostate (79,052; 2,233; 2.8%), kidney (32,263; 1,765; 5.5%), and colorectal carcinoma (172,039; 940; 0.5%). Kidney cancer had the highest rate of hospitalization for pathologic fracture (24 hospitalizations/1,000 newly diagnosed cases). Patients hospitalized for pathologic fracture had higher billed costs and longer length of stay. Limitations Hospital administrative discharge data includes only billed charges from the inpatient hospitalization. Conclusion Metastatic lung, breast, prostate, kidney, and colorectal carcinoma are commonly seen in patients hospitalized with pathologic fracture. Pathologic fracture is associated with higher costs and longer hospitalization. Funding Grants from the NIH (K08 AR060164-01A), American Society for Surgery of the Hand Hand Surgeon Scientist Award grant, and University of Rochester Medical Center Clinical & Translational Science Institute grants, in addition to institutional support from the University of Rochester and Pennsylvania State University Medical Centers.

AB - Background Breast, lung, thyroid, kidney, and prostate cancers have high rates of metastasis to bone in cadaveric studies. However, bone metastasis at time of death may be less clinically relevant than occurrence of pathologic fracture and related morbidity. No population-based studies have examined the economic burden from pathologic fractures. Objectives To determine primary tumors in patients hospitalized with metastatic disease who sustain pathologic and nonpathologic (traumatic) fractures, and to estimate the costs and lengths of stay for associated hospitalizations in patients with metastatic disease and fracture. Methods The Healthcare Cost and Utilization Project’s National (Nationwide) Inpatient Sample was used to retrospectively identify patients with metastatic disease in the United States who had been hospitalized with pathologic or nonpathologic fracture during from 2003-2010. Patients with pathologic fracture were compared with patients with nonpathologic fractures and those without fractures. Results Of 674,680 hospitalizations of patients with metastatic disease, 17,313 hospitalizations were for pathologic fractures and 12,770 were for nonpathologic fractures. The most common primary cancers in patients hospitalized for fractures were lung (187,059 hospitalizations; 5,652 pathologic fractures; 3% of hospitalizations were for pathologic fractures), breast (124,303; 5,252; 4.2%), prostate (79,052; 2,233; 2.8%), kidney (32,263; 1,765; 5.5%), and colorectal carcinoma (172,039; 940; 0.5%). Kidney cancer had the highest rate of hospitalization for pathologic fracture (24 hospitalizations/1,000 newly diagnosed cases). Patients hospitalized for pathologic fracture had higher billed costs and longer length of stay. Limitations Hospital administrative discharge data includes only billed charges from the inpatient hospitalization. Conclusion Metastatic lung, breast, prostate, kidney, and colorectal carcinoma are commonly seen in patients hospitalized with pathologic fracture. Pathologic fracture is associated with higher costs and longer hospitalization. Funding Grants from the NIH (K08 AR060164-01A), American Society for Surgery of the Hand Hand Surgeon Scientist Award grant, and University of Rochester Medical Center Clinical & Translational Science Institute grants, in addition to institutional support from the University of Rochester and Pennsylvania State University Medical Centers.

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