Ranjeet Jeevan1, David A Cromwell2, John P Browne3, Christopher M Caddy4, Jerome Pereira5, Carmel Sheppard6, Kimberley Greenaway7, Jan H P van der Meulen8. 1. Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK; St. Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside L35 5DR, UK. 2. Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Electronic address: dcromwell@rcseng.ac.uk. 3. Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Department of Epidemiology and Public Health, University College Cork, Cork, Ireland. 4. Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, 4 Claremont Place, Sheffield S10 2JF, UK. 5. James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Gorleston, Great Yarmouth, Norfolk NR31 6LA, UK; University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ, UK. 6. Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, Hampshire PO6 3LY, UK. 7. The Health and Social Care Information Centre, 1 Trevelyan Square, Leeds, West Yorkshire LS1 6AE, UK. 8. Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Abstract
OBJECTIVES: This paper summarises the findings of a national audit of mastectomy and breast reconstruction surgery carried out in England. It describes patterns of treatment, and the clinical and patient-reported quality of life outcomes associated with these types of procedure. DESIGN: Prospective cohort study. SETTING: All 150 National Health Service hospital groups (NHS trusts) in England that provided mastectomy or breast reconstruction surgery, along with six NHS trusts in Wales and Scotland and 114 independent hospitals. PARTICIPANTS: Women aged 16 years and over undergoing mastectomy with or without immediate breast reconstruction, or primary delayed breast reconstruction, between 1st January 2008 and 31st March 2009. MAIN OUTCOME MEASURES: Reconstructive utilisation, post-operative complications and sequelae, and patient-reported satisfaction and quality of life. RESULTS: Overall, 21% of the 16,485 women who had mastectomy underwent immediate reconstruction. However, the proportion varied between regions from 9% to 43% (p < 0.001). Levels of patient satisfaction with information, choice and the quality of care were high. The proportion of women who experienced local complications was 10.30% (95% CI 9.78-10.84) for mastectomy surgery, ranged from 11.02% (9.31-12.92) to 18.24% (14.80-22.10) for different immediate reconstructive procedures, and from 5.00% (2.76-8.25) to 19.86% (16.21-23.94) for types of delayed reconstruction. Breast appearance and overall well-being scores reported 18 months after surgery were higher among women having immediate breast reconstruction compared to mastectomy only. Postoperative outcomes were similar across providers.. CONCLUSIONS: The Audit found women were highly satisfied with their peri-operative care, with hospital providers achieving similar outcomes. English providers should examine how to reduce the variation in rates of immediate reconstruction.
OBJECTIVES: This paper summarises the findings of a national audit of mastectomy and breast reconstruction surgery carried out in England. It describes patterns of treatment, and the clinical and patient-reported quality of life outcomes associated with these types of procedure. DESIGN: Prospective cohort study. SETTING: All 150 National Health Service hospital groups (NHS trusts) in England that provided mastectomy or breast reconstruction surgery, along with six NHS trusts in Wales and Scotland and 114 independent hospitals. PARTICIPANTS: Women aged 16 years and over undergoing mastectomy with or without immediate breast reconstruction, or primary delayed breast reconstruction, between 1st January 2008 and 31st March 2009. MAIN OUTCOME MEASURES: Reconstructive utilisation, post-operative complications and sequelae, and patient-reported satisfaction and quality of life. RESULTS: Overall, 21% of the 16,485 women who had mastectomy underwent immediate reconstruction. However, the proportion varied between regions from 9% to 43% (p < 0.001). Levels of patient satisfaction with information, choice and the quality of care were high. The proportion of women who experienced local complications was 10.30% (95% CI 9.78-10.84) for mastectomy surgery, ranged from 11.02% (9.31-12.92) to 18.24% (14.80-22.10) for different immediate reconstructive procedures, and from 5.00% (2.76-8.25) to 19.86% (16.21-23.94) for types of delayed reconstruction. Breast appearance and overall well-being scores reported 18 months after surgery were higher among women having immediate breast reconstruction compared to mastectomy only. Postoperative outcomes were similar across providers.. CONCLUSIONS: The Audit found women were highly satisfied with their peri-operative care, with hospital providers achieving similar outcomes. English providers should examine how to reduce the variation in rates of immediate reconstruction.
Authors: Michael A Howard; Mark Sisco; Katharine Yao; David J Winchester; Ermilo Barrera; Jeremy Warner; Jennifer Jaffe; Peter Hulick; Kristine Kuchta; Andrea L Pusic; Stephen F Sener Journal: J Surg Oncol Date: 2016-07-08 Impact factor: 3.454
Authors: Jennica Platt; Toni Zhong; Rahim Moineddin; Gillian L Booth; Alexandra M Easson; Kimberly Fernandes; Peter Gozdyra; Nancy N Baxter Journal: World J Surg Date: 2015-08 Impact factor: 3.352
Authors: Andrea L Pusic; Evan Matros; Neil Fine; Edward Buchel; Gayle M Gordillo; Jennifer B Hamill; Hyungjin M Kim; Ji Qi; Claudia Albornoz; Anne F Klassen; Edwin G Wilkins Journal: J Clin Oncol Date: 2017-03-27 Impact factor: 44.544
Authors: Wess A Cohen; Lily R Mundy; Tiffany N S Ballard; Anne Klassen; Stefan J Cano; John Browne; Andrea L Pusic Journal: J Plast Reconstr Aesthet Surg Date: 2015-11-26 Impact factor: 2.740