C R Baliski1,2, R E Pataky3. 1. Department of Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, Kelowna, BC, Canada. cbaliski@bccancer.bc.ca. 2. Department of Surgery, University of British Columbia, Vancouver, BC, Canada. cbaliski@bccancer.bc.ca. 3. Canadian Centre for Applied Research in Cancer Control, BC Cancer Agency, Vancouver, BC, Canada.
Abstract
BACKGROUND: The reported reexcision rates vary significantly for patients with invasive breast cancer undergoing breast-conserving surgery (BCS). This variability is a function of both the positive pathologic margin rate and the interpretation of an adequate pathologic margin. The influence of the SSO/ASTRO margin guidelines on reexcision rates and the potential cost savings is of interest from both quality and health economics perspectives. METHODS: A retrospective analysis of all patients undergoing BCS during a 3-year period (January 1, 2010-December 31, 2012) was performed. The reexcision rate and the pathologic margin status were assessed to determine the number of patients with pathologic negative margins who underwent reexcision. A decision analysis using previously published case costing information was used to determine the potential savings associated with avoidance of reoperation for patients meeting guidelines criteria. RESULTS: The analysis included 512 patients who underwent attempted BCS for invasive breast cancer. Reoperations occurred for 25% (126/512) of the BCS cohort, but this rate could potentially be decreased to 16% (44/512) if these guidelines were applied. Based on our cost model, application of the guidelines would provide a potential cost savings of $698 (95% confidence interval $523-$893) per patient undergoing attempted BCS in our population. CONCLUSIONS: Adherence to the SSO-ASTRO guidelines could prevent one-third of reoperations among patients undergoing BCS. This would result in significant cost savings to the health care system while avoiding unnecessary operations. Use of guidelines has the potential to improve the quality of care provided to patients.
BACKGROUND: The reported reexcision rates vary significantly for patients with invasive breast cancer undergoing breast-conserving surgery (BCS). This variability is a function of both the positive pathologic margin rate and the interpretation of an adequate pathologic margin. The influence of the SSO/ASTRO margin guidelines on reexcision rates and the potential cost savings is of interest from both quality and health economics perspectives. METHODS: A retrospective analysis of all patients undergoing BCS during a 3-year period (January 1, 2010-December 31, 2012) was performed. The reexcision rate and the pathologic margin status were assessed to determine the number of patients with pathologic negative margins who underwent reexcision. A decision analysis using previously published case costing information was used to determine the potential savings associated with avoidance of reoperation for patients meeting guidelines criteria. RESULTS: The analysis included 512 patients who underwent attempted BCS for invasive breast cancer. Reoperations occurred for 25% (126/512) of the BCS cohort, but this rate could potentially be decreased to 16% (44/512) if these guidelines were applied. Based on our cost model, application of the guidelines would provide a potential cost savings of $698 (95% confidence interval $523-$893) per patient undergoing attempted BCS in our population. CONCLUSIONS: Adherence to the SSO-ASTRO guidelines could prevent one-third of reoperations among patients undergoing BCS. This would result in significant cost savings to the health care system while avoiding unnecessary operations. Use of guidelines has the potential to improve the quality of care provided to patients.
Authors: Jennifer Yu; Leisha C Elmore; Amy E Cyr; Rebecca L Aft; William E Gillanders; Julie A Margenthaler Journal: J Am Coll Surg Date: 2017-04-14 Impact factor: 6.113
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Authors: Kathryn Ottolino-Perry; Anam Shahid; Stephanie DeLuca; Viktor Son; Mayleen Sukhram; Fannong Meng; Zhihui Amy Liu; Sara Rapic; Nayana Thalanki Anantha; Shirley C Wang; Emilie Chamma; Christopher Gibson; Philip J Medeiros; Safa Majeed; Ashley Chu; Olivia Wignall; Alessandra Pizzolato; Cheryl F Rosen; Liis Lindvere Teene; Danielle Starr-Dunham; Iris Kulbatski; Tony Panzarella; Susan J Done; Alexandra M Easson; Wey L Leong; Ralph S DaCosta Journal: Breast Cancer Res Date: 2021-07-12 Impact factor: 6.466