Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statisticsBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4505 (Published 12 July 2012) Cite this as: BMJ 2012;345:e4505
- R Jeevan, research fellow1,
- D A Cromwell, senior lecturer 12,
- M Trivella, lecturer13,
- G Lawrence, director4,
- O Kearins, regional deputy director of breast screening quality assurance4,
- J Pereira, consultant breast surgeon 5,
- C Sheppard, consultant breast care nurse 6,
- C M Caddy, consultant plastic surgeon 7,
- J H P van der Meulen, professor of clinical epidemiology12
- 1Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK
- 2Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
- 3UK Cochrane Centre, National Institute for Health Research, Oxford OX2 7LG, UK
- 4West Midlands Cancer Intelligence Unit, University of Birmingham, Birmingham B15 2TT, UK
- 5James Paget University Hospitals NHS Foundation Trust, Great Yarmouth NR31 6LA, UK
- 6Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
- 7Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
- Correspondence to: D Cromwell
- Accepted 8 June 2012
Objectives To examine whether rate of reoperation after breast conserving surgery is associated with patients’ characteristics and investigate whether reoperation rates vary among English NHS trusts.
Design Cohort study using patient level data from hospital episode statistics.
Setting English NHS trusts.
Participants Adult women who had breast conserving surgery between 1 April 2005 and 31 March 2008.
Main outcome measure Reoperation rates after primary breast conserving surgery within 3 months, adjusted using logistic regression for tumour type, age, comorbidity, and socioeconomic deprivation. Tumours were grouped by whether a carcinoma in situ component was coded at the time of the primary breast conserving surgery.
Results 55 297 women had primary breast conserving surgery in 156 NHS trusts during the three year period. 11 032 (20.0%, 95% confidence interval 19.6% to 20.3%) women had at least one reoperation. 10 212 (18.5%, 18.2% to 18.8%) had one reoperation only; of these, 5943 (10.7%, 10.5% to 11.0%) had another breast conserving procedure and 4269 (7.7%, 7.5% to 7.9%) had a mastectomy. Of the 45 793 women with isolated invasive disease, 8229 (18.0%) had at least one reoperation. In comparison, 2803 (29.5%) of the 9504 women with carcinoma in situ had at least one reoperation (adjusted odds ratio 1.9, 95% confidence interval 1.8 to 2.0). Substantial differences were found in the adjusted reoperation rates among the NHS trusts (10th and 90th centiles 12.2% and 30.2%).
Conclusion: One in five women who had breast conserving surgery in England had a reoperation. Reoperation was nearly twice as likely when the tumour had a carcinoma in situ component coded. Women should be informed of this reoperation risk when deciding on the type of surgical treatment of their breast cancer.
We thank the Department of Health for providing the hospital episode statistics data used in this study.
Contributors: RJ, DAC, GL, and OK conceived the study. RJ, DAC, GL, OK, JHPvdM, JP, CS, and CMC designed the study. MT and DAC did the statistical analyses. RJ, DAC, and JHPvdM wrote the manuscript. MT, GL, OK, JP, CS, and CMC commented on and revised drafts. DAC is the guarantor.
Funding: This study was not commissioned. JHPvdM received a national public health career scientist award from the Department of Health and NHS research and development programme.
Competing interests: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The study is exempt from UK National Research Ethics Committee approval as it involved analysis of an existing dataset of anonymised data for service evaluation. Approvals for the use of hospital episode statistics data were obtained as part of the standard hospitals episode statistics approval process.
Data sharing: No additional data available.
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