Impact of analysis of frozen-section margin on reoperation rates in women undergoing lumpectomy for breast cancer: Evaluation of the National Surgical Quality Improvement Program data
| Autor: | Amy C. Degnim, Kristine M. Thomsen, James W. Jakub, Gary L. Keeney, Judy C. Boughey, Elizabeth B. Habermann, David R. Farley, Tina J. Hieken, Clive S. Grant, John B. Osborn |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Reoperation medicine.medical_specialty Databases Factual medicine.medical_treatment Breast Neoplasms Mastectomy Segmental Logistic regression Patient satisfaction Breast cancer Frozen Sections Humans Medicine Aged Retrospective Studies Aged 80 and over Frozen section procedure Intraoperative Care business.industry Carcinoma Ductal Breast Lumpectomy Cancer Retrospective cohort study Middle Aged medicine.disease Surgery Carcinoma Intraductal Noninfiltrating Logistic Models Treatment Outcome Multivariate Analysis Female business Mastectomy |
| Zdroj: | Surgery. 156:190-197 |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2014.03.025 |
| Popis: | Reoperation for positive margins after lumpectomy for breast cancer is common. Intraoperative analysis of frozen-section (FS) margins permits immediate re-excision, avoiding reoperation. The aim of this study was to compare reoperation rates between an institution using routine FS analysis of all margins and the National Surgical Quality Improvement Program (NSQIP) data.We designed a retrospective cohort analysis comparing the NSQIP data from a FS single institution with the national NSQIP data from 2006 to 2010. Women undergoing lumpectomy for cancer were identified (N = 24,217), and reoperation rates were compared by the use of χ(2) analyses and multivariable logistic regression. During this time period, NSQIP did not differentiate between reoperations for complications or oncologic reasons. Reoperation rates for mastectomy patients (N = 21,734) and lumpectomy patients without cancer (N = 2,777) over the same time period were analyzed as controls, because reoperations after these procedures likely would be for reasons other than positive margins.The 30-day reoperation rate after lumpectomy for cancer was greater nationally than at the FS institution (13.2% vs 3.6%, P.001). Multivariable analysis showed that patients in the national NSQIP data set were over four times as likely to undergo reoperation as those at the FS institution's (odds ratio 4.19). The reoperation rates were similar between the two, both for patients undergoing mastectomy (4.7% vs 4.5%, P = .84) and those undergoing lumpectomy for benign diagnosis (2.9% vs 5.9%, P = .39).Intraoperative FS margin analysis decreases the number of reoperations for patients undergoing breast conservation for breast cancer. This technique has important implications for patient satisfaction and cost of care. |
| Databáze: | OpenAIRE |
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