title: Effect of surgeon's caseload on the quality of surgery and breast cancer recurrence.
abstract: The aim of this study was to evaluate the effects of the caseloads of individual surgeons on breast cancer primary care and outcome. The extent of primary breast cancer and axillary surgery and the appearance of local recurrences were evaluated for 1377 women operated in Pirkanmaa region between 1.1.1997 and 31.12.2001 and followed- up at least until 31.12.2008 or death. Caseloads of each surgeon were divided into three categories: over 550, 100-200 and under 60. Breast conserving surgery was performed more often by surgeons with the highest (OR 1.32) and the middle (OR 1.54) caseload volumes compared to those with the lowest volumes (p = 0.018). Surgeons with the lowest caseloads also dissected fewer lymph nodes (mean 9.4 versus 11.2 in the highest and 10.9 in the middle caseload volumes; p ≤ 0.001). There were no differences in recurrences between the groups during the mean follow-up time of 8.9 years.
authors.affiliation: Department of Palliative Medicine, Tampere University Hospital and Medical School, University of Tampere, 33014 Tampere, Finland. paivi.peltoniemi@uta.fi
authors.forename: Päivi
authors.initials: P
authors.lastname: Peltoniemi
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Kaija
authors.initials: K
authors.lastname: Holli
authors.forename: Liisa
authors.initials: L
authors.lastname: Pylkkänen
mesh_terms: D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008197:Lymph Node Excision / Q000592:standards / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011787:Quality of Health Care; D012042:Registries; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data*