Processes of Care in Breast Reconstruction and the Long-Term Impact of a Comprehensive Breast Center.
BACKGROUND
Increased emphasis has been placed on process outcomes for breast cancer care, but limited data exists on these measures for breast reconstruction. These processes are likely to be impacted by increased centralization of care into comprehensive breast centers (CBC). Our study objectives were to define measures for processes of care in breast reconstruction and to determine the effect of a CBC on these measures.


METHODS
A 5-year review was performed of patients who underwent mastectomy with or without reconstruction for a newly diagnosed breast cancer between 2010 and 2014, which spans from 1 year before to 4 years after introduction of our CBC.


RESULTS
A total of 4179 patients were reviewed. The referral rate for immediate reconstruction increased from 40.0 to 70.8 % (p < .001), and the immediate reconstruction rate increased from 36.7 to 65.0 % (p < .001), both plateauing in the fourth study year. The interval between surgical oncology and plastic surgery consultation decreased (from 9.2 to 2.5 days; p < .001), and stabilized in the second study year. The interval between plastic surgery consultation and surgery decreased throughout the entire study period (from 37.6 to 20.8 days; p < .001), resulting in continued improvements in the interval between surgical oncology consultation and surgery (from 46.8 to 23.3 days, p < .001).


CONCLUSIONS
In breast reconstruction, a CBC results in improvements in process outcomes, some of which are realized in the short-term and others in the long-term. The timeliness of treatment of patients who undergo immediate postmastectomy reconstruction can be similar to targets set for patients who undergo mastectomy alone.
Department of Plastic Surgery, The Ohio State University, Columbus, OH, USA. Albert.Chao@osumc.edu.
Albert H
AH
Chao
Department of Plastic Surgery, The Ohio State University, Columbus, OH, USA.
Ibrahim
I
Khansa
Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA.
William B
WB
Farrar
Department of Plastic Surgery, The Ohio State University, Columbus, OH, USA.
Michael J
MJ
Miller
D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002173:Cancer Care Facilities / Q000458:organization & administration*; D003191:Comprehensive Health Care / Q000379:methods*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D058996:Quality Improvement; D012017:Referral and Consultation; D012189:Retrospective Studies