title: Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.affiliation: 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.
authors.forename: Ranjeet
authors.initials: R
authors.lastname: Jeevan
authors.affiliation: 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.
authors.forename: David A
authors.initials: DA
authors.lastname: Cromwell
authors.affiliation: 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.
authors.forename: John P
authors.initials: JP
authors.lastname: Browne
authors.affiliation: Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, 4 Claremont Place, Sheffield S10 2JF, UK.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Caddy
authors.affiliation: 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.
authors.forename: Jerome
authors.initials: J
authors.lastname: Pereira
authors.affiliation: Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, Hampshire PO6 3LY, UK.
authors.forename: Carmel
authors.initials: C
authors.lastname: Sheppard
authors.affiliation: The Health and Social Care Information Centre, 1 Trevelyan Square, Leeds, West Yorkshire LS1 6AE, UK.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Greenaway
authors.affiliation: 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.
authors.forename: Jan H P
authors.initials: JH
authors.lastname: van der Meulen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D006801:Humans; D016462:Mammaplasty / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000706:statistics & numerical data*; D008485:Medical Audit; D008875:Middle Aged; D010549:Personal Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life; D013222:State Medicine; D006113:United Kingdom
keywords: Breast cancer; Breast reconstruction; England; Mastectomy; Outcomes; Quality of life