| Abstract |
Background: Repeat operations after breast-conserving surgery (BCS) for cancer have been termed "epidemic." To aid improvement activities, we sought to identify those National Cancer Data Base (NCDB) characteristics that were associated with reoperations.
Methods: A retrospective cohort of patients with invasive breast cancer undergoing initial BCS in the NCDB from 2004 to 2015 were identified. Univariate, multivariate, ranking (effect size and R
Results: In 1226 facilities, 84,462 (16.1%) of 524,594 patients underwent reoperations after BCS [range 0-75%; 10th/90th performance percentiles = 6.6%/25%]. Of 18 factors associated with reoperations, facility ID was the highest-ranked. Its estimated impact on the odds of reoperation was more than 10 times greater than any other factor considered, followed by tumor size, neo-adjuvant chemotherapy receipt, patient age, cancer histology, and nodal status. Reoperations after the year of the SSO-ASTRO margin guideline declined significantly compared with prior years. Significant inter-facility reoperation variability persisted after risk adjustment for more than a dozen distinct patient, facility, tumor, and treatment characteristics.
Conclusion: In the NCDB, significant inter-facility variability exists regardless of case volume, case mix, and risk adjustment. There were fewer reoperations after the SSO-ASTRO guideline. An endorsed target rate of 10% was achieved by only 1 in 4 facilities. The most impactful determinant of reoperation was the facility itself. Thus, all stakeholders should consider participation in improvement activities. Such activities will benefit from risk-adjusted profiling; the relevant adjustors were identified.
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| MeSH term(s) |
Academic Medical Centers ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Antineoplastic Agents/therapeutic use ; Antineoplastic Agents, Hormonal/therapeutic use ; Breast Neoplasms/metabolism ; Breast Neoplasms/pathology ; Breast Neoplasms/surgery ; Cancer Care Facilities ; Carcinoma, Ductal, Breast/metabolism ; Carcinoma, Ductal, Breast/pathology ; Carcinoma, Ductal, Breast/surgery ; Carcinoma, Lobular/metabolism ; Carcinoma, Lobular/pathology ; Carcinoma, Lobular/surgery ; Female ; Hospitals/statistics & numerical data ; Hospitals, Community ; Hospitals, High-Volume ; Hospitals, Low-Volume ; Humans ; Lymph Nodes/pathology ; Mastectomy, Segmental ; Middle Aged ; Neoadjuvant Therapy/statistics & numerical data ; Neoplasm Staging ; Practice Guidelines as Topic ; Receptor, ErbB-2/metabolism ; Receptors, Estrogen/metabolism ; Receptors, Progesterone/metabolism ; Reoperation/statistics & numerical data ; Retrospective Studies ; Risk Factors ; Tumor Burden |
| Chemical Substances |
Antineoplastic Agents ; Antineoplastic Agents, Hormonal ; Receptors, Estrogen ; Receptors, Progesterone ; ERBB2 protein, human (EC 2.7.10.1) ; Receptor, ErbB-2 (EC 2.7.10.1) |
| Language |
English |
| Publishing date |
2019-07-03 |
| Publishing country |
England |
| Document type |
Journal Article |
| ZDB-ID |
632519-1 |
| ISSN |
1532-2157 ; 0748-7983 |
| ISSN (online) |
1532-2157 |
| ISSN |
0748-7983 |
| DOI |
10.1016/j.ejso.2019.07.002 |
| Database |
MEDical Literature Analysis and Retrieval System OnLINE |
