A statewide approach to reducing re-excision rates for women with breast conserving surgery

Jessica R Schumacher, Elise H Lawson, Amanda L Kong, Joseph J Weber, Jeanette May, Jeffrey Landercasper, Bret Hanlon, Nicholas Marka, Manasa Venkatesh, Randi S Cartmill, Sudha Pavuluri Quamme, Connor Nikolay, Caprice C Greenberg, Aurora Complex General Surgical Oncology Faculty

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Test the effectiveness of benchmarked performance reports based on existing discharge data paired with a statewide intervention to implement evidence-based strategies on breast re-excision rates. Summary background: Breast-conserving surgery (BCS) is a common breast cancer surgery performed in a range of hospital settings. Studies have demonstrated variations in post-BCS re-excision rates, identifying it as a high-value improvement target. Methods: Wisconsin Hospital Association discharge data (2017-2019) were used to compare 60-day re-excision rates following BCS for breast cancer. The analysis estimated the difference in the average change pre-to post-intervention between Surgical Collaborative of Wisconsin (SCW) and non-participating hospitals using a logistic mixed-effects model with repeated measures, adjusting for age, payer, and hospital volume, including hospitals as random effects. The intervention included five collaborative meetings in 2018-2019 where surgeon champions shared guideline updates, best practices/challenges, and facilitated action planning. Confidential benchmarked performance reports were provided. Results: In 2017, there were 3,692 breast procedures in SCW and 1,279 in non-participating hospitals; hospital-level re-excision rates ranged from 5% to >50%. There was no statistically significant baseline difference in re-excision rates between SCW and non-participating hospitals (16.1% vs. 17.1%, P=0.47). Re-excision significantly decreased for SCW but not for non-participating hospitals (OR=0.69, 95%CI=0.52-0.91). Conclusions: Benchmarked performance reports and collaborative quality improvement can decrease post-BCS re-excisions, increase quality, and decrease costs. Our study demonstrates the effective use of administrative data as a platform for state-wide quality collaboratives. Using existing data requires fewer resources and offers a new paradigm that promotes participation across practice settings.

Original languageAmerican English
JournalAnnals of surgery
DOIs
StatusPublished - Oct 1 2022

Keywords

  • breast conservation
  • re-excision

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