Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline
Background: A 2014 SSO-ASTRO guideline on surgical margins aimed to reduce unnecessary reoperation after breast conserving surgery (BCS). We investigate whether publication of the guideline was associated with a reduction in reoperation in Western Australia (WA). Methods: In this retrospective, popu...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-06-01
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| Series: | Breast |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0960977623000139 |
| _version_ | 1797804680286306304 |
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| author | M. Luke Marinovich Christobel M. Saunders Gavin Pereira Nehmat Houssami |
| author_facet | M. Luke Marinovich Christobel M. Saunders Gavin Pereira Nehmat Houssami |
| author_sort | M. Luke Marinovich |
| collection | DOAJ |
| description | Background: A 2014 SSO-ASTRO guideline on surgical margins aimed to reduce unnecessary reoperation after breast conserving surgery (BCS). We investigate whether publication of the guideline was associated with a reduction in reoperation in Western Australia (WA). Methods: In this retrospective, population-based cohort study, cases of newly-diagnosed breast cancer were identified from the WA Cancer Registry. Linkage to the Hospital Morbidity Data Collection identified index BCS for invasive cancer between January 2009 and June 2018 (N = 8059) and reoperation within 90 days. Pre-guideline (2009–2013) and post-guideline (2014–2018) reoperation proportions were compared, and temporal trends were estimated with generalised linear regression. Results: The pre-guideline reoperation proportion was 25.8% compared with 21.7% post-guideline (difference −4.0% [95% CI —5.9, −2.2, p < 0.001], odds ratio [OR] 0.80 [95% CI 0.72, 0.89, p < 0.001]). Absolute reductions were similar for repeat BCS (16.3% versus 14.6%; difference −1.8% [95% CI —3.4, −0.2, p = 0.03]) and conversion to mastectomy (9.4% versus 7.2%; difference −2.2% [95% CI —3.4, −1.0, p < 0.001]). Over the study period, there was an annual absolute change in reoperation of −0.8% (95% CI —1.2, −0.5, p < 0.001). Accounting for this linear trend, the difference in reoperation between time periods was −0.5% (95% CI —4.3, 3.3; p = 0.81), reflecting a non-significant reduction in conversion to mastectomy. Conclusions: Comparisons of pre- versus post-guideline time periods in WA showed reductions in reoperation that were similar to international estimates; however, an annual decline in reoperation predated the guideline. Analyses that do not account for temporal trends are likely to overestimate changes in reoperation associated with the guideline. |
| first_indexed | 2024-03-13T05:40:53Z |
| format | Article |
| id | doaj.art-9f9530139c734560810a80e9331b0853 |
| institution | Directory Open Access Journal |
| issn | 1532-3080 |
| language | English |
| last_indexed | 2024-03-13T05:40:53Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Breast |
| spelling | doaj.art-9f9530139c734560810a80e9331b08532023-06-14T04:32:38ZengElsevierBreast1532-30802023-06-0169499505Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guidelineM. Luke Marinovich0Christobel M. Saunders1Gavin Pereira2Nehmat Houssami3The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia; Curtin School of Population Health, Curtin University, Kent Street, WA, Australia; Corresponding author. The Daffodil Centre The University of Sydney, a joint venture with Cancer Council NSW Sydney, NSW, Australia.Division of Surgery, Medical School, The University of Western Australia, Crawley, WA, Australia; Department of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Vic, AustraliaCurtin School of Population Health, Curtin University, Kent Street, WA, AustraliaThe Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, AustraliaBackground: A 2014 SSO-ASTRO guideline on surgical margins aimed to reduce unnecessary reoperation after breast conserving surgery (BCS). We investigate whether publication of the guideline was associated with a reduction in reoperation in Western Australia (WA). Methods: In this retrospective, population-based cohort study, cases of newly-diagnosed breast cancer were identified from the WA Cancer Registry. Linkage to the Hospital Morbidity Data Collection identified index BCS for invasive cancer between January 2009 and June 2018 (N = 8059) and reoperation within 90 days. Pre-guideline (2009–2013) and post-guideline (2014–2018) reoperation proportions were compared, and temporal trends were estimated with generalised linear regression. Results: The pre-guideline reoperation proportion was 25.8% compared with 21.7% post-guideline (difference −4.0% [95% CI —5.9, −2.2, p < 0.001], odds ratio [OR] 0.80 [95% CI 0.72, 0.89, p < 0.001]). Absolute reductions were similar for repeat BCS (16.3% versus 14.6%; difference −1.8% [95% CI —3.4, −0.2, p = 0.03]) and conversion to mastectomy (9.4% versus 7.2%; difference −2.2% [95% CI —3.4, −1.0, p < 0.001]). Over the study period, there was an annual absolute change in reoperation of −0.8% (95% CI —1.2, −0.5, p < 0.001). Accounting for this linear trend, the difference in reoperation between time periods was −0.5% (95% CI —4.3, 3.3; p = 0.81), reflecting a non-significant reduction in conversion to mastectomy. Conclusions: Comparisons of pre- versus post-guideline time periods in WA showed reductions in reoperation that were similar to international estimates; however, an annual decline in reoperation predated the guideline. Analyses that do not account for temporal trends are likely to overestimate changes in reoperation associated with the guideline.http://www.sciencedirect.com/science/article/pii/S0960977623000139Breast neoplasmsBreast-conserving surgeryPractice guidelinesHealth care evaluation mechanisms |
| spellingShingle | M. Luke Marinovich Christobel M. Saunders Gavin Pereira Nehmat Houssami Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline Breast Breast neoplasms Breast-conserving surgery Practice guidelines Health care evaluation mechanisms |
| title | Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline |
| title_full | Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline |
| title_fullStr | Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline |
| title_full_unstemmed | Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline |
| title_short | Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline |
| title_sort | rates of reoperation after breast conserving cancer surgery in western australia before and after publication of the sso astro margins guideline |
| topic | Breast neoplasms Breast-conserving surgery Practice guidelines Health care evaluation mechanisms |
| url | http://www.sciencedirect.com/science/article/pii/S0960977623000139 |
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