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

Authors

Jessica R. Schumacher, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
Elise H. Lawson, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
Amanda L. Kong, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Joseph J. Weber, Advocate Aurora HealthFollow
Jeanette May, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
Jeffrey Landercasper, Gundersen Health System and Gundersen Medical Foundation, La Crosse, WI, USA.
Bret Hanlon, Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.
Nicholas Marka, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA.
Manasa Venkatesh, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
Randi S. Cartmill, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
Sudha Pavuluri Quamme, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
Connor Nikolay, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
Caprice C. Greenberg, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA.

Recommended Citation

Schumacher JR, Lawson EH, Kong AL, et al. A Statewide Approach to Reducing Re-excision Rates for Women With Breast-conserving Surgery. Ann Surg. 2022;276(4):665-672. doi:10.1097/SLA.0000000000005590

Affiliations

Aurora Medical Center, Grafton

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.

Type

Article

PubMed ID

35837946