National trends and regional variation in immediate breast reconstruction rates

Jeevan, Ranjeet; Mennie, JC; Mohanna, Pari-Naz; O’Donoghue, J.M.; Rainsbury, RM; Cromwell, DA

doi:10.1002/bjs.10161

Cited by 78 publications

(66 citation statements)

References 26 publications

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“…Over the years, accredited breast centers in the United States have transitioned away from only PM or M procedures and incorporated reconstructive procedures. However, previous retrospective analyses comparing PM to M showed nationwide inconsistencies between annual breast reconstruction trends [7–14]. Understanding trends in breast surgery is extremely important with regards to prioritizing surgical training requirements for surgical trainees, and identifying the status quo so that improvements or adjustments could be made if these trends were not favored by the present outcomes data.…”

Section: Introductionmentioning

confidence: 81%

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Jonczyk

Jean

Graham

et al. 2018

Breast Cancer Res Treat

147

118

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Purpose Breast cancer surgical techniques are evolving. Few studies have analyzed national trends for the multitude of surgical options that include partial mastectomy (PM), mastectomy without reconstruction (M), mastectomy with reconstruction (M+R), and PM with oncoplastic reconstruction (OS). We hypothesize that the use of M is declining and likely correlates with the rise of surgery with reconstructive options (M+R, OS). Methods A retrospective cohort analysis was conducted using the ACS-NSQIP database from 2005 to 2016 and ICD codes for IBC and DCIS. Patients were then grouped together based on current procedural terminology (CPT) codes for PM, M, M+R, and OS. In each group, categories were sorted again based on additional reconstructive procedures. Data analysis was conducted via Pearson’s chi-squared test for demographics, linear regression, and a non-parametric Mann-Kendall test to assess a temporal trend. Results The patient cohort consisted of 256,398 patients from the NSQIP data base; 197,387 meet inclusion criteria diagnosed with IBC or DCIS. Annual breast surgery trends changed as follows: PM 46.3–46.1% (p = 0.21), M 35.8–26.4% (p = 0.001), M+R 15.9–23.0% (p = 0.03), and OS 1.8–4.42% (p = 0.001). Analyzing the patient cohort who underwent breast conservation, categorical analysis showed a decreased use of PM alone (96–91%) with an increased use of OS (4–9%). For the patient cohort undergoing mastectomy, M alone decreased (69–53%); M+R with muscular flap decreased (9–2%); and M+R with implant placement increased (20–40%)—all three trends p < 0.0001. Conclusion The modern era of breast surgery is identified by the increasing use of reconstruction for patients undergoing breast conservation (in the form of OS) and mastectomy (in the form of M+R). Our study provides data showing significant trends that will impact the future of both breast cancer surgery and breast training programs.

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Section: Introductionmentioning

confidence: 81%

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Jonczyk

Jean

Graham

et al. 2018

Breast Cancer Res Treat

147

118

View full text Add to dashboard Cite

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“…Concomitant with increased utilization of mastectomy, the proportion of women choosing to undergo immediate or delayed breast reconstruction increased at least 1.6-fold in the US and over two-fold in England from 2005 to 2014. [4–6] The increase in immediate breast reconstruction is primarily associated with increased use of prosthetic-based reconstruction,[4, 7] and increased use of reconstruction in higher-risk women. [8]…”

Section: Introductionmentioning

confidence: 99%

Surveillance and Prevention of Surgical Site Infections in Breast Oncologic Surgery with Immediate Reconstruction

Olsen

Nickel

Fox

2017

Curr Treat Options Infect Dis

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Opinion Statement Surgical site infection (SSI) after immediate breast reconstruction is much more common than would be expected after a clean surgical procedure. Although the SSI rates reported in individual studies are quite variable, there are no obvious explanations for the variation in infection rates between institutions. The microbiology of these SSIs is unusual, with higher proportions of infections caused by atypical Myobacterium species and Gram-negative bacilli than would be expected for this anatomic site. In an effort to prevent SSIs, many surgeons use a variety of different practices including irrigation and soaking of implants with antibiotic solutions and prolonged duration of prophylactic antibiotics, although the literature to support these practices is very sparse. In particular, prolonged use of antibiotics post-discharge is concerning due to the potential for harm, including increased risk of Clostridium difficile infection, development of antibiotic resistant organisms, and drug-related allergic reactions. With higher rates of mastectomy and breast implant reconstruction in women with early-stage breast cancer, including greater utilization of reconstruction in higher-risk individuals, the number of women suffering from infection after oncologic reconstruction will likely continue to increase. It is imperative that more research be done to identify modifiable factors associated with increased risk of infection. It is also essential that larger studies with rigorous study designs be performed to identify optimal strategies to decrease the risk of SSI in this vulnerable population.

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“…9 There is still substantial regional variation in IBR rate across the English regions ranging from 13.1% to 36.7%. 10 In our study, there was no significant difference in the cohort of mastectomy patients between 2015 and 2016 apart from the introduction of a dedicated OP MDM. We recognize that several complex factors are associated with uptake of breast reconstruction following mastectomy (age, ethnicity, income, education, tumor characteristics, healthrelated issues, surgeon/hospital factors, and psychological or other factors).…”

Section: Discussionmentioning

confidence: 84%

Improved immediate breast reconstruction as a result of oncoplastic multidisciplinary meeting

Lim

Gammal

2017

European Journal of Surgical Oncology (EJSO)

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National trends and regional variation in immediate breast reconstruction rates

Abstract: The national IR rate increased throughout the study period. Substantial regional variation remains, although considerable time has elapsed since a period of service reorganization, guideline revision and a national audit.

Cited by 78 publications

References 26 publications

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Surveillance and Prevention of Surgical Site Infections in Breast Oncologic Surgery with Immediate Reconstruction

Improved immediate breast reconstruction as a result of oncoplastic multidisciplinary meeting

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