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. 2012 Jul 12:345:e4505.
doi: 10.1136/bmj.e4505.

Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics

R Jeevan  1 , D A Cromwell, M Trivella, G Lawrence, O Kearins, J Pereira, C Sheppard, C M Caddy, J H P van der Meulen
Affiliations

Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics

R Jeevan et al. BMJ. .

Abstract

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.

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Conflict of interest statement

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.

Figures

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Fig 1 Inclusion of patients in study
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Fig 2 Unadjusted breast reoperation rates in English NHS acute hospital organisations for women who had breast conserving surgery for breast cancer between 2005 and 2008. BCS=breast conserving surgery
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Fig 3 Risk adjusted breast reoperation rates in English NHS acute hospital organisations for women who had breast conserving surgery for breast cancer between 2005 and 2008. BCS=breast conserving surgery
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