Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline.
Background: A 2014 SSO-ASTRO guideline on surgical margins aimed to reduce unnecessary reoperation after breast conserving surgery (BCS). We investigate whether publication of the guideline was associated with a reduction in reoperation in Western Australia (WA). Methods: In this retrospective, popu...
| Main Authors: | , , , |
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| Format: | Journal Article |
| Language: | English |
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Elsevier
2023
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| Online Access: | http://purl.org/au-research/grants/nhmrc/1099655 http://hdl.handle.net/20.500.11937/93237 |
| _version_ | 1848765715850461184 |
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| author | Marinovich, Luke Saunders, Christobel Pereira, Gavin Houssami, Nehmat |
| author_facet | Marinovich, Luke Saunders, Christobel Pereira, Gavin Houssami, Nehmat |
| author_sort | Marinovich, Luke |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background: A 2014 SSO-ASTRO guideline on surgical margins aimed to reduce unnecessary reoperation after breast conserving surgery (BCS). We investigate whether publication of the guideline was associated with a reduction in reoperation in Western Australia (WA). Methods: In this retrospective, population-based cohort study, cases of newly-diagnosed breast cancer were identified from the WA Cancer Registry. Linkage to the Hospital Morbidity Data Collection identified index BCS for invasive cancer between January 2009 and June 2018 (N = 8059) and reoperation within 90 days. Pre-guideline (2009–2013) and post-guideline (2014–2018) reoperation proportions were compared, and temporal trends were estimated with generalised linear regression. Results: The pre-guideline reoperation proportion was 25.8% compared with 21.7% post-guideline (difference −4.0% [95% CI —5.9, −2.2, p < 0.001], odds ratio [OR] 0.80 [95% CI 0.72, 0.89, p < 0.001]). Absolute reductions were similar for repeat BCS (16.3% versus 14.6%; difference −1.8% [95% CI —3.4, −0.2, p = 0.03]) and conversion to mastectomy (9.4% versus 7.2%; difference −2.2% [95% CI —3.4, −1.0, p < 0.001]). Over the study period, there was an annual absolute change in reoperation of −0.8% (95% CI —1.2, −0.5, p < 0.001). Accounting for this linear trend, the difference in reoperation between time periods was −0.5% (95% CI —4.3, 3.3; p = 0.81), reflecting a non-significant reduction in conversion to mastectomy. Conclusions: Comparisons of pre- versus post-guideline time periods in WA showed reductions in reoperation that were similar to international estimates; however, an annual decline in reoperation predated the guideline. Analyses that do not account for temporal trends are likely to overestimate changes in reoperation associated with the guideline. |
| first_indexed | 2025-11-14T11:39:40Z |
| format | Journal Article |
| id | curtin-20.500.11937-93237 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | eng |
| last_indexed | 2025-11-14T11:39:40Z |
| publishDate | 2023 |
| publisher | Elsevier |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-932372023-10-10T06:29:28Z Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline. Marinovich, Luke Saunders, Christobel Pereira, Gavin Houssami, Nehmat Breast neoplasms Breast-conserving surgery Health care evaluation mechanisms Practice guidelines Humans Female Breast Neoplasms Mastectomy, Segmental Mastectomy Reoperation Retrospective Studies Cohort Studies Western Australia Margins of Excision Humans Breast Neoplasms Mastectomy Mastectomy, Segmental Reoperation Retrospective Studies Cohort Studies Western Australia Female Margins of Excision Background: A 2014 SSO-ASTRO guideline on surgical margins aimed to reduce unnecessary reoperation after breast conserving surgery (BCS). We investigate whether publication of the guideline was associated with a reduction in reoperation in Western Australia (WA). Methods: In this retrospective, population-based cohort study, cases of newly-diagnosed breast cancer were identified from the WA Cancer Registry. Linkage to the Hospital Morbidity Data Collection identified index BCS for invasive cancer between January 2009 and June 2018 (N = 8059) and reoperation within 90 days. Pre-guideline (2009–2013) and post-guideline (2014–2018) reoperation proportions were compared, and temporal trends were estimated with generalised linear regression. Results: The pre-guideline reoperation proportion was 25.8% compared with 21.7% post-guideline (difference −4.0% [95% CI —5.9, −2.2, p < 0.001], odds ratio [OR] 0.80 [95% CI 0.72, 0.89, p < 0.001]). Absolute reductions were similar for repeat BCS (16.3% versus 14.6%; difference −1.8% [95% CI —3.4, −0.2, p = 0.03]) and conversion to mastectomy (9.4% versus 7.2%; difference −2.2% [95% CI —3.4, −1.0, p < 0.001]). Over the study period, there was an annual absolute change in reoperation of −0.8% (95% CI —1.2, −0.5, p < 0.001). Accounting for this linear trend, the difference in reoperation between time periods was −0.5% (95% CI —4.3, 3.3; p = 0.81), reflecting a non-significant reduction in conversion to mastectomy. Conclusions: Comparisons of pre- versus post-guideline time periods in WA showed reductions in reoperation that were similar to international estimates; however, an annual decline in reoperation predated the guideline. Analyses that do not account for temporal trends are likely to overestimate changes in reoperation associated with the guideline. 2023 Journal Article http://hdl.handle.net/20.500.11937/93237 10.1016/j.breast.2023.01.013 eng http://purl.org/au-research/grants/nhmrc/1099655 http://purl.org/au-research/grants/nhmrc/1173991 http://purl.org/au-research/grants/nhmrc/1194410 http://creativecommons.org/licenses/by-nc-nd/4.0/ Elsevier fulltext |
| spellingShingle | Breast neoplasms Breast-conserving surgery Health care evaluation mechanisms Practice guidelines Humans Female Breast Neoplasms Mastectomy, Segmental Mastectomy Reoperation Retrospective Studies Cohort Studies Western Australia Margins of Excision Humans Breast Neoplasms Mastectomy Mastectomy, Segmental Reoperation Retrospective Studies Cohort Studies Western Australia Female Margins of Excision Marinovich, Luke Saunders, Christobel Pereira, Gavin Houssami, Nehmat Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline. |
| title | Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline. |
| title_full | Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline. |
| title_fullStr | Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline. |
| title_full_unstemmed | Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline. |
| title_short | Rates of reoperation after breast conserving cancer surgery in Western Australia before and after publication of the SSO-ASTRO margins guideline. |
| title_sort | rates of reoperation after breast conserving cancer surgery in western australia before and after publication of the sso-astro margins guideline. |
| topic | Breast neoplasms Breast-conserving surgery Health care evaluation mechanisms Practice guidelines Humans Female Breast Neoplasms Mastectomy, Segmental Mastectomy Reoperation Retrospective Studies Cohort Studies Western Australia Margins of Excision Humans Breast Neoplasms Mastectomy Mastectomy, Segmental Reoperation Retrospective Studies Cohort Studies Western Australia Female Margins of Excision |
| url | http://purl.org/au-research/grants/nhmrc/1099655 http://purl.org/au-research/grants/nhmrc/1099655 http://purl.org/au-research/grants/nhmrc/1099655 http://hdl.handle.net/20.500.11937/93237 |