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Surgeon re-excision rates after breast-conserving therapy (BCT) varied significantly, decreasing after a 2014 guideline. Higher surgeon volume and older patient age were linked to fewer re-excisions, suggesting opportunities for quality improvement.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Health Services Research

Background:

  • Breast-conserving therapy (BCT) is a standard treatment for breast cancer.
  • Re-excision after BCT can lead to increased patient morbidity and healthcare costs.
  • Understanding variations in re-excision rates is crucial for optimizing patient care.

Purpose of the Study:

  • To investigate surgeon-specific re-excision rates following BCT.
  • To identify factors associated with variations in re-excision practices.
  • To assess the impact of the 2014 "no tumor on ink" consensus guideline on re-excision rates.

Main Methods:

  • Retrospective analysis of Medicare claims data from 2012-2018.
  • Identification of patients undergoing BCT and subsequent breast resections within 12 months.
  • Hierarchical logistic regression to evaluate patient and physician characteristics associated with re-excision.

Main Results:

  • 19.0% of 291,065 female Medicare beneficiaries undergoing BCT had re-excision.
  • Re-excision rates decreased from 22.1% pre-guideline (2012-2013) to 17.2% post-guideline (2015-2018).
  • Higher surgeon volume and patient age (>75 years) were associated with lower re-excision odds.

Conclusions:

  • Significant variation exists in surgeon re-excision rates after BCT.
  • The 2014 guideline was associated with a reduction in re-excision rates.
  • Establishing re-excision frequency metrics can guide quality improvement initiatives to reduce unnecessary procedures.