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

Area of Science:

• Surgical Quality Improvement
• Health Services Research
• Oncology

Background:

• Breast-conserving surgery (BCS) is a common breast cancer treatment.
• Re-excision rates after BCS vary significantly across hospitals, representing a key area for quality improvement.
• Identifying and addressing variations in re-excision rates is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate the effectiveness of benchmarked performance reports and a statewide intervention on breast re-excision rates.
• To assess the impact of implementing evidence-based strategies on post-BCS re-excision rates.
• To determine if collaborative quality improvement efforts can reduce re-excision rates in breast cancer surgery.

Main Methods:

• Utilized Wisconsin Hospital Association discharge data (2017-2019) to analyze 60-day re-excision rates following BCS.
• Employed a logistic mixed-effects model to compare changes in re-excision rates pre- and post-intervention between participating and nonparticipating hospitals.
• The intervention involved collaborative meetings focused on guideline updates, best practices, and action planning, supported by confidential benchmarked performance reports.

Main Results:

• No significant baseline difference in re-excision rates was observed between the Surgical Collaborative of Wisconsin (SCW) and nonparticipating hospitals (16.1% vs. 17.1%).
• Re-excision rates significantly decreased in hospitals participating in the SCW intervention (OR=0.69, 95% CI=0.52-0.91).
• Hospitals not participating in the intervention did not show a significant decrease in re-excision rates.

Conclusions:

• Benchmarked performance reports coupled with collaborative quality improvement initiatives can effectively reduce post-BCS re-excision rates.
• The study demonstrates the successful application of administrative data for statewide quality collaboratives.
• This approach offers a resource-efficient paradigm for improving surgical quality across diverse practice settings.