Journal of the American College of Surgeons
Journal of the American College of Surgeons
5 years ago

Evaluating the Effect of Margin Consensus Guideline Publication on Operative Patterns and Financial Impact of Breast Cancer Surgery

This study sought to evaluate re-excision rates, patient satisfaction with their breasts, and health care costs before and after publication of 2014 Society of Surgical Oncology – American Society of Radiation Oncology consensus guideline on margins for breast conservation surgery with whole-breast irradiation for stage I-II breast cancer at an academic institution. Study Design Patients with stage I and II invasive carcinoma who underwent partial mastectomy were divided into two groups based on whether they were treated before (PRE) or after (POST) guideline publication in March 2014. Groups were compared with respect to re-excision rates, conversion to mastectomy, specimen volumes, average cost per patient of surgical care, and prospectively-collected patient post-procedure quality of life (QOL). Results A total of 237 patients who underwent partial mastectomy were examined: 126 in the PRE group and 111 in the POST group. Patients in the POST group were less likely to require re-excision (9% POST vs.37% PRE, p<0.001) and were less likely to undergo conversion to mastectomy (5% POST vs. 14% PRE, p=0.02). After consensus guideline publication, average operative cost per patient decreased ($4874 POST vs. $5772 PRE, p<0.001), and patients had improved breast QOL scores (77/100 POST vs. 61/100 PRE, p=0.03). On multivariable analysis, publication of the consensus statement was an independent predictor of decreased re-excision rates (Odds Ratio (OR) 0.17, 95% CI 0.08-0.38, p<0.001) and operative cost per patient (OR = 0.14, 95% CI 0.78-0.30, p<0.001). Conclusions Widespread implementation of the consensus guideline on margins for breast conservation surgery will likely lead to the intended improvements in operative and financial outcomes as well as patient satisfaction with breast conserving surgery.

Teaser

Publication of the Society of Surgical Oncology—American Society of Radiation Oncology consensus guideline on margins for breast conservation surgery resulted in a significant decrease in the number of re-excisions and operative costs, decreased conversion to mastectomy, and improved patient satisfaction with their breast after surgery.

Publisher URL: www.sciencedirect.com/science

DOI: S1072751518301042

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