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Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data.
BMJ Open 2018; 8(4):e020858BO

Abstract

OBJECTIVES

To investigate between-hospital variation in the probability of reoperation within 90 days of initial breast-conserving surgery (BCS), and the contribution of health system-level and other factors.

DESIGN

Population-based, retrospective cohort study.

SETTING

New South Wales (NSW), Australia.

PARTICIPANTS

Linked administrative hospitalisation data were used to define a cohort of adult women undergoing initial BCS for breast cancer in NSW between 1 July 2002 and 31 December 2013.

PRIMARY OUTCOME MEASURES

Multilevel, cross-classified models with patients clustered within hospitals and residential areas were used to examine factors associated with any reoperation, and either re-excision or mastectomy, within 90 days.

RESULTS

Of 34 458 women undergoing BCS, 29.1% underwent reoperation within 90 days, half of which were mastectomies. Overall, the probability of reoperation decreased slightly over time. However, there were divergent patterns by reoperation type; the probability of re-excision increased alongside a concomitant decrease in the probability of mastectomy. Significant between-hospital variation was observed. Non-metropolitan location and surgery at low-volume hospitals were associated with a higher overall probability of reoperation, and of mastectomy specifically, after accounting for patient-level factors, calendar year and area-level socioeconomic status. The magnitude of association with geographical location and surgical volume decreased over time.

CONCLUSIONS

Reoperation rates within 90 days of BCS varied significantly between hospitals. For women undergoing mastectomy after BCS, this represents a dramatic change in clinical course. Multilevel modelling suggests unwarranted clinical variation may be an issue, likely due to disparities in access to multidisciplinary breast cancer care and preoperative diagnostic procedures. However, the observed reduction in disparities over time is encouraging and indicates that guidelines and policy initiatives have the potential to improve regional breast cancer care.

Authors+Show Affiliations

Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.Breast Cancer Network Australia, Camberwell, Victoria, Australia.Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29643165

Citation

van Leeuwen, Marina T., et al. "Reoperation After Breast-conserving Surgery for Cancer in Australia: Statewide Cohort Study of Linked Hospital Data." BMJ Open, vol. 8, no. 4, 2018, pp. e020858.
van Leeuwen MT, Falster MO, Vajdic CM, et al. Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data. BMJ Open. 2018;8(4):e020858.
van Leeuwen, M. T., Falster, M. O., Vajdic, C. M., Crowe, P. J., Lujic, S., Klaes, E., ... Sedrakyan, A. (2018). Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data. BMJ Open, 8(4), pp. e020858. doi:10.1136/bmjopen-2017-020858.
van Leeuwen MT, et al. Reoperation After Breast-conserving Surgery for Cancer in Australia: Statewide Cohort Study of Linked Hospital Data. BMJ Open. 2018 04 10;8(4):e020858. PubMed PMID: 29643165.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data. AU - van Leeuwen,Marina T, AU - Falster,Michael O, AU - Vajdic,Claire M, AU - Crowe,Philip J, AU - Lujic,Sanja, AU - Klaes,Elizabeth, AU - Jorm,Louisa, AU - Sedrakyan,Art, Y1 - 2018/04/10/ PY - 2018/4/13/entrez PY - 2018/4/13/pubmed PY - 2019/2/28/medline KW - breast cancer KW - breast conserving surgery KW - cohort KW - health services research KW - reoperation SP - e020858 EP - e020858 JF - BMJ open JO - BMJ Open VL - 8 IS - 4 N2 - OBJECTIVES: To investigate between-hospital variation in the probability of reoperation within 90 days of initial breast-conserving surgery (BCS), and the contribution of health system-level and other factors. DESIGN: Population-based, retrospective cohort study. SETTING: New South Wales (NSW), Australia. PARTICIPANTS: Linked administrative hospitalisation data were used to define a cohort of adult women undergoing initial BCS for breast cancer in NSW between 1 July 2002 and 31 December 2013. PRIMARY OUTCOME MEASURES: Multilevel, cross-classified models with patients clustered within hospitals and residential areas were used to examine factors associated with any reoperation, and either re-excision or mastectomy, within 90 days. RESULTS: Of 34 458 women undergoing BCS, 29.1% underwent reoperation within 90 days, half of which were mastectomies. Overall, the probability of reoperation decreased slightly over time. However, there were divergent patterns by reoperation type; the probability of re-excision increased alongside a concomitant decrease in the probability of mastectomy. Significant between-hospital variation was observed. Non-metropolitan location and surgery at low-volume hospitals were associated with a higher overall probability of reoperation, and of mastectomy specifically, after accounting for patient-level factors, calendar year and area-level socioeconomic status. The magnitude of association with geographical location and surgical volume decreased over time. CONCLUSIONS: Reoperation rates within 90 days of BCS varied significantly between hospitals. For women undergoing mastectomy after BCS, this represents a dramatic change in clinical course. Multilevel modelling suggests unwarranted clinical variation may be an issue, likely due to disparities in access to multidisciplinary breast cancer care and preoperative diagnostic procedures. However, the observed reduction in disparities over time is encouraging and indicates that guidelines and policy initiatives have the potential to improve regional breast cancer care. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/29643165/Reoperation_after_breast_conserving_surgery_for_cancer_in_Australia:_statewide_cohort_study_of_linked_hospital_data_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=29643165 DB - PRIME DP - Unbound Medicine ER -