Prospective Review of Practice Patterns in Breast Cancer Surgery Facilitates Rapid Practice Change, Reduced Clinical...

Breast cancer management requires complex decision-making and varies widely at international, national, and institutional levels. Our study evaluates the impact of nonpunitive, real-time reviews of individual surgeons' practice patterns within a single institution.

Data from a prospective breast cancer database from the prior 12-month period were reviewed every 6 months in unblinded sessions. Surgeons compared their practices with those of their colleagues during three review sessions, without any benchmarks or punitive measures.

A mean of 663 cases were reviewed for each 12-month period. Significant changes in practice patterns were observed, including notable reductions in re-excision rates (20.1% vs. 11.2%, p < 0.001), sentinel lymph node (SLN) biopsy utilization in patients over 70 with favorable biology (24.2% vs. 12.2%, p = 0.037), intraoperative SLN analysis in surgery-first patients (28.7% vs. 2.7%, p < 0.001), and immediate breast reconstruction (46.2% vs. 34.7%, p = 0.027). Additionally, there were significant increases in the use of breast conserving therapy (75.3% vs. 83.1%, p = 0.006) and outpatient mastectomy (58.4% vs. 79.9%, p < 0.001). Clinical variation in intraoperative SLN analysis and prophylactic measures was notably reduced. These adjustments resulted in an estimated annual cost saving of $467 619.

Practice pattern reviews significantly altered surgical practices, reducing clinical variation and demonstrating that strategic investments in quality initiatives can greatly enhance resource utilization and generate substantial cost savings.