A statewide approach to reducing re-excision rates for women with breast conserving surgery
Schumacher JR, Lawson EH, Kong AL, et al. A Statewide Approach to Reducing Re-excision Rates for Women with Breast Conserving Surgery [published online ahead of print, 2022 Jul 15]. Ann Surg. 2022;10.1097/SLA.0000000000005590. doi:10.1097/SLA.0000000000005590
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.