Reoperation Costs in Attempted Breast-Conserving Surgery: A Decision Analysis

Pataky, Reka; Baliski, Christopher

doi:10.3747/co.23.2989

Cited by 42 publications

(32 citation statements)

References 45 publications

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“…The ability to discern healthy tissue from tumor tissue could potentially improve intraoperative margin evaluation during breast-conserving surgery and reduce the number of re-excisions, which are currently reported to be as high as 20% of patients. [1][2][3][4][5][6] Previous research showed the potential of DRS to provide surgical guidance during breast-conserving surgery based on the ability of DRS to discriminate healthy breast tissue from tumor tissue. [7][8][9][10][11] The reported accuracies for discriminating healthy breast tissue from tumor tissue reached up to 92% in vivo, albeit that these results were obtained in patients who did not have any "neoadjuvant chemotherapy."…”

Section: Introductionmentioning

confidence: 99%

Influence of neoadjuvant chemotherapy on diffuse reflectance spectra of tissue in breast surgery specimens

et al. 2019

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Diffuse reflectance spectroscopy (DRS) can discriminate different tissue types based on optical characteristics. Since this technology has the ability to detect tumor tissue, several groups have proposed to use DRS for margin assessment during breast-conserving surgery for breast cancer. Nowadays, an increasing number of patients with breast cancer are being treated by neoadjuvant chemotherapy. Limited research has been published on the influence of neoadjuvant chemotherapy on the optical characteristics of the tissue. Hence, it is unclear whether margin assessment based on DRS is feasible in this specific group of patients. We investigate whether there is an effect of neoadjuvant chemotherapy on optical measurements of breast tissue. To this end, DRS measurements were performed on 92 ex-vivo breast specimens from 92 patients, treated with neoadjuvant chemotherapy and without neoadjuvant chemotherapy. Generalized estimating equation (GEE) models were generated, comparing the measurements of patients with and without neoadjuvant chemotherapy in datasets of different tissue types using a significance level of 5%. As input for the GEE models, either the intensity at a specific wavelength or a fit parameter, derived from the spectrum, was used. In the evaluation of the intensity, no influence of neoadjuvant chemotherapy was found, since none of the wavelengths were significantly different between the measurements with and the measurements without neoadjuvant chemotherapy in any of the datasets. These results were confirmed by the analysis of the fit parameters, which showed a significant difference for the amount of collagen in only one dataset. All other fit parameters were not significant for any of the datasets. These findings may indicate that assessment of the resection margin with DRS is also feasible in the growing population of breast cancer patients who receive neoadjuvant chemotherapy. However, it is possible that we did not detect neoadjuvant chemotherapy effect in the some of the datasets due to the small number of measurements in those datasets.

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Section: Introductionmentioning

confidence: 99%

Influence of neoadjuvant chemotherapy on diffuse reflectance spectra of tissue in breast surgery specimens

et al. 2019

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“… 13 The financial costs of reoperation are also considerable. 14 Population-based studies in the USA 10 and England 11 estimate the rate of reoperation ranges between 20% and 30%, though recent data suggest a downtrend in rates following the dissemination of clinical guidelines regarding surgical margins. 15 Previous Australian data are limited; a rate of 30% was estimated based on linked registry from Western Australia, 1998–2000.…”

Section: Introductionmentioning

confidence: 99%

Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data

et al. 2018

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ObjectivesTo investigate between-hospital variation in the probability of reoperation within 90 days of initial breast-conserving surgery (BCS), and the contribution of health system-level and other factors.DesignPopulation-based, retrospective cohort study.SettingNew South Wales (NSW), Australia.ParticipantsLinked administrative hospitalisation data were used to define a cohort of adult women undergoing initial BCS for breast cancer in NSW between 1 July 2002 and 31 December 2013.Primary outcome measuresMultilevel, cross-classified models with patients clustered within hospitals and residential areas were used to examine factors associated with any reoperation, and either re-excision or mastectomy, within 90 days.ResultsOf 34 458 women undergoing BCS, 29.1% underwent reoperation within 90 days, half of which were mastectomies. Overall, the probability of reoperation decreased slightly over time. However, there were divergent patterns by reoperation type; the probability of re-excision increased alongside a concomitant decrease in the probability of mastectomy. Significant between-hospital variation was observed. Non-metropolitan location and surgery at low-volume hospitals were associated with a higher overall probability of reoperation, and of mastectomy specifically, after accounting for patient-level factors, calendar year and area-level socioeconomic status. The magnitude of association with geographical location and surgical volume decreased over time.ConclusionsReoperation rates within 90 days of BCS varied significantly between hospitals. For women undergoing mastectomy after BCS, this represents a dramatic change in clinical course. Multilevel modelling suggests unwarranted clinical variation may be an issue, likely due to disparities in access to multidisciplinary breast cancer care and preoperative diagnostic procedures. However, the observed reduction in disparities over time is encouraging and indicates that guidelines and policy initiatives have the potential to improve regional breast cancer care.

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“…All studies used a cost–benefit analysis and focused on the perioperative phase. Two studies used a prediction model, whereby a decision‐tree analysis was undertaken to model the cost impact of re‐excision following BCS. Only direct medical costs were reported; indirect costs (not directly accountable to the operation) and intangible costs (unquantifiable cost relating to an identifiable source) were not estimated in any of the reviewed literature.…”

Section: Resultsmentioning

confidence: 99%

“…Although there have been a number of reports describing the cost burden associated with reoperations after breast surgery, there has been no attempt to review or synthesize this literature. Moreover, investigators have attempted to define the costs of reoperations after BCS using best estimates of patient charges or decision models that use hypothetical cohorts. Although there is an obvious cost burden to health systems, the idiosyncratic nature of costing methodologies used creates uncertainty around the magnitude and location of cost drivers across the BCS care pathway.…”

Section: Introductionmentioning

confidence: 99%

Patient-level costs in margin re-excision for breast-conserving surgery

Grant

Al-Khudairi

John

et al. 2019

Journal of British Surgery

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Background: High rates of reoperation following breast-conserving surgery (BCS) for positive margins are associated with costs to healthcare providers. The aim was to assess the quality of evidence on reported re-excision costs and compare the direct patient-level costs between patients undergoing successful BCS versus reoperations after BCS. Methods: The study used data from women who had BCS with or without reoperation at a single institution between April 2015 and March 2016. A systematic review of health economic analysis in BCS was conducted and scored using the Quality of Health Economic Studies (QHES) instrument. Financial data were retrieved using the Patient-Level Information and Costing Systems (PLICS) for patients. Exchange rates used were: US $1 = £0⋅75, £1 = €1⋅14 and US $1 = €0⋅85. Results: The median QHES score was 47 (i.q.r. 32⋅5-79). Only two of nine studies scored in the upper QHES quartile (score at least 75). Costs of initial lumpectomy and reoperation were in the range US $1234-11786 and $655-9136 respectively. Over a 12-month interval, 153 patients had definitive BCS and 59 patients underwent reoperation. The median cost of reoperations after BCS (59 patients) was £4511 (range 1752-18 019), representing an additional £2136 per patient compared with BCS without reoperation (P < 0⋅001). Conclusion: The systematic review demonstrated variation in methodological approach to cost estimates and a paucity of high-quality cost estimate studies for reoperations. Extrapolating local PLICS data to a national level suggests that getting BCS right first time could result in substantial savings.

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Reoperation Costs in Attempted Breast-Conserving Surgery: A Decision Analysis

Abstract: Background Breast-conserving surgery (bcs) is the preferred surgical approach for most patients with early-stage

Cited by 42 publications

References 45 publications

Influence of neoadjuvant chemotherapy on diffuse reflectance spectra of tissue in breast surgery specimens

Influence of neoadjuvant chemotherapy on diffuse reflectance spectra of tissue in breast surgery specimens

Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data

Patient-level costs in margin re-excision for breast-conserving surgery

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