A Statewide Approach to Reducing Re-excision Rates for Women With Breast-conserving Surgery

Jessica R. Schumacher, Elise H. Lawson, Amanda L. Kong, Joseph J. Weber, Jeanette May, Jeffrey Landercasper, Bret Hanlon, Nicholas Marka, Manasa Venkatesh, Randi S. Cartmill, Sudha Pavuluri Quamme, Connor Nikolay, Caprice C. Greenberg

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: Test the effectiveness of benchmarked performance reports based on existing discharge data paired with a statewide intervention to implement evidence-based strategies on breast re-excision rates. Background: Breast-conserving surgery (BCS) is a common breast cancer surgery performed in a range of hospital settings. Studies have demonstrated variations in post-BCS re-excision rates, identifying it as a high-value improvement target. Methods: Wisconsin Hospital Association discharge data (2017-2019) were used to compare 60-day re-excision rates following BCS for breast cancer. The analysis estimated the difference in the average change preintervention to postintervention between Surgical Collaborative of Wisconsin (SCW) and nonparticipating hospitals using a logistic mixed-effects model with repeated measures, adjusting for age, payer, and hospital volume, including hospitals as random effects. The intervention included 5 collaborative meetings in 2018 to 2019 where surgeon champions shared guideline updates, best practices/challenges, and facilitated action planning. Confidential benchmarked performance reports were provided. Results: In 2017, there were 3692 breast procedures in SCW and 1279 in nonparticipating hospitals; hospital-level re-excision rates ranged from 5% to >50%. There was no statistically significant baseline difference in re-excision rates between SCW and nonparticipating hospitals (16.1% vs. 17.1%, P=0.47). Re-excision significantly decreased for SCW but not for nonparticipating hospitals (odds ratio=0.69, 95% confidence interval=0.52-0.91). Conclusions: Benchmarked performance reports and collaborative quality improvement can decrease post-BCS re-excisions, increase quality, and decrease costs. Our study demonstrates the effective use of administrative data as a platform for statewide quality collaboratives. Using existing data requires fewer resources and offers a new paradigm that promotes participation across practice settings.

Original languageEnglish (US)
Pages (from-to)665-672
Number of pages8
JournalAnnals of surgery
Volume276
Issue number4
DOIs
StatePublished - Oct 1 2022

Bibliographical note

Funding Information:
This project was supported by funding from the Wisconsin Partnership Program (#4233), the National Cancer Institute (P30CA014520-45S5), and the University of Wisconsin-Madison Department of Surgery.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • breast cancer
  • breast cancer surgery
  • breast-conserving treatment
  • collaborative
  • performance assessment
  • quality of care
  • re-excision

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