title: Breast cancer surgery trends and outcomes: results from a National Department of Veterans Affairs study.
abstract: BACKGROUND
  This study examined trends and outcomes for breast cancer surgery performed at Department of Veterans Affairs (VA) hospitals.
  
  
  METHODS
  We examined breast cancer operations performed in VA hospitals from October 1991 to September 1997. Data from the VA National Surgical Quality Improvement Program, surgical pathology reports, discharge data, and outpatient data were used. Surgical outcomes included postoperative length of stay, 30-day morbidity rates, 1-year surgery-related readmission rates, and mortality. An expert panel of breast cancer clinicians identified surgery-related hospital readmissions. Hierarchical regression analysis was used to identify patient, provider, and hospital characteristics associated with postoperative length of stay, and 30-day morbidity.
  
  
  RESULTS
  From October 1991 to September 1997 1,333 breast operations were performed, ranging from 1 to 38 on average per hospital; 478 operations were for breast cancer. Among breast cancer surgery patients, 25% were men. Thirty-day morbidity rates, 1-year hospital readmission rates, and mortality were very low for both men and women. Postoperative length of stay averaged 6.8 days. Lower income, longer operation times, and older age increased the likelihood of 30-day morbidity. Lower functional status, older age, longer operation time, and lower average annual volume of procedures increased postoperative length of stay. Documentation of the extent of disease and surgical margin in pathology reports was poor in medical records.
  
  
  CONCLUSIONS
  Hospital stays were longer, and morbidity and readmission rates for patients having breast cancer operations at VA hospitals were comparable to those reported for private sector hospitals.
authors.affiliation: Midwest Center for Health Services and Policy Research, VA Information Resource Center, Edward Hines Jr. VA Administration Hospital, PO Box 5000 (151V), Fifth & Roosevelt Roads, Building 1 Room C305, Hines, IL 60141-5000, USA.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Hynes
authors.forename: Frances
authors.initials: F
authors.lastname: Weaver
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.forename: Frank
authors.initials: F
authors.lastname: Folk
authors.forename: David J
authors.initials: DJ
authors.lastname: Winchester
authors.forename: Meri
authors.initials: M
authors.lastname: Mallard
authors.forename: Dolores
authors.initials: D
authors.lastname: Ippolito
authors.forename: Bharat
authors.initials: B
authors.lastname: Thakkar
authors.forename: William
authors.initials: W
authors.lastname: Henderson
authors.forename: Shukri
authors.initials: S
authors.lastname: Khuri
authors.forename: Jennifer
authors.initials: J
authors.lastname: Daley
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018567:Breast Neoplasms, Male / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007902:Length of Stay; D008297:Male; D008408:Mastectomy / Q000639:trends; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome