Quality measures for breast cancer surgery: initial validation of feasibility and assessment of variation among surgeons.
OBJECTIVE
To identify and quantify surgical outcomes as possible quality measures of initial breast cancer surgery and to assess variation among surgeons.


METHODS
Descriptive analysis of concurrently collected outcome measures.


METHODS
University hospital with a designated breast cancer center.


METHODS
Patients with a preoperative diagnosis of invasive breast cancer or ductal carcinoma in situ undergoing their initial cancer surgery from April 1, 2003, to March 30, 2008.


METHODS
Eight measures were identified: (1) total mastectomy rate; (2) close (<1 mm) and positive margin rate following initial partial mastectomy; (3) number of operations required in breast conservation; (4) number of nodes obtained from sentinel lymph node biopsy; (5) number of nodes from axillary dissection; (6) proportion of patients with positive sentinel lymph node biopsy undergoing axillary dissection; (7) use of intraoperative lymph node assessment; and (8) time from diagnosis to surgery.


RESULTS
Nine hundred ten operations (218 for ductal carcinoma in situ, 692 for invasive breast cancer) were performed by 6 surgeons. Variation existed among surgeons in the combined close and positive margin rate, number of nodes obtained from sentinel lymph node biopsy, and use of intraoperative lymph node assessment. No significant variation was seen for the overall mastectomy rate, mean number of operations, positive margin rate alone, and number of lymph nodes from axillary dissection.


CONCLUSIONS
Quality indicators for breast cancer surgery can be identified and readily monitored. Outcome variation exists at a high-volume breast center. Further study into the causes and effects of this variation on short- and long-term patient outcomes as well as health care costs is needed.
McCahill
Laurence E
LE
Department of Surgery, Division of Surgical Oncology, University of Vermont, Burlington, VT 05405, USA. laurence.mccahill@uvm.edu
Privette
Alicia
A
James
Ted
T
Sheehey-Jones
Johanna
J
Ratliff
John
J
Majercik
Donald
D
Krag
David N
DN
Stanley
Mary
M
Harlow
Seth
S
D000293:Adolescent; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery; D044584:Carcinoma, Ductal / Q000473:pathology / Q000601:surgery; D016009:Chi-Square Distribution; D005240:Feasibility Studies; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D016896:Treatment Outcome