Measuring Surgical Waiting Times in Breast Cancer: Admission to Surgery Versus Biopsy Result to Surgery

Background: Preoperative timelines may lengthen due to tailored evaluation and system constraints. We examined whether two complementary measures of time-to-surgery (TTS)-admission-to-surgery (A-TTS) and biopsy-result-to-surgery (B-TTS)-behave similarly and whether parallel tracking offers service value. Methods: In a single-center retrospective cohort of eligible women undergoing upfront surgery for invasive breast cancer (2010-2021; n = 167), we reported quality indicators for timeliness (target attainment, agreement and discordance, the interval gap, and the surgery-to-adjuvant interval), while analyzing recurrence as the primary endpoint and overall survival as secondary. Discrimination analyses, logistic regression, and Cox models were used; non-proportional hazards were handled with a log-time interaction centered at 24 months. Results: The two time measures were not interchangeable: discordant cases were frequent and pointed to different bottlenecks. A-TTS ≤ 24 days was independently associated with recurrence (OR 3.16; 95% CI 1.13-8.82) and showed a large early hazard for death at 24 months that attenuated over time (HR 22.83; 95% CI 6.44-80.98; interaction HR 0.06; 95% CI 0.02-0.21), whereas B-TTS showed no association. Conclusions: Lymphovascular invasion remained the strongest pathologic correlate of survival. Tracking both intervals, paired with brief, reason-coded reviews of discordant cases, may support scheduling, quality dashboards, and breach governance better than a single TTS metric.