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

Judy C Boughey, Tina J Hieken, James W Jakub, Amy C Degnim, Clive S. Grant, David R. Farley, Kristine M. Thomsen, John B. Osborn, Gary Keeney, Elizabeth B Habermann

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Abstract

Background 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. Methods 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 χ2 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. Results 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). Conclusion 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.

Original languageEnglish (US)
Pages (from-to)190-197
Number of pages8
JournalSurgery (United States)
Volume156
Issue number1
DOIs
StatePublished - 2014

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Segmental Mastectomy
Frozen Sections
Quality Improvement
Reoperation
Breast Neoplasms
Mastectomy
Neoplasms
Patient Satisfaction
Breast
Cohort Studies
Logistic Models
Odds Ratio
Costs and Cost Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

@article{f3a5f6bb37cb4ffd9be9b7200c16d2b9,
title = "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",
abstract = "Background 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. Methods 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 χ2 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. Results 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). Conclusion 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.",
author = "Boughey, {Judy C} and Hieken, {Tina J} and Jakub, {James W} and Degnim, {Amy C} and Grant, {Clive S.} and Farley, {David R.} and Thomsen, {Kristine M.} and Osborn, {John B.} and Gary Keeney and Habermann, {Elizabeth B}",
year = "2014",
doi = "10.1016/j.surg.2014.03.025",
language = "English (US)",
volume = "156",
pages = "190--197",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Impact of analysis of frozen-section margin on reoperation rates in women undergoing lumpectomy for breast cancer

T2 - Evaluation of the National Surgical Quality Improvement Program data

AU - Boughey, Judy C

AU - Hieken, Tina J

AU - Jakub, James W

AU - Degnim, Amy C

AU - Grant, Clive S.

AU - Farley, David R.

AU - Thomsen, Kristine M.

AU - Osborn, John B.

AU - Keeney, Gary

AU - Habermann, Elizabeth B

PY - 2014

Y1 - 2014

N2 - Background 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. Methods 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 χ2 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. Results 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). Conclusion 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.

AB - Background 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. Methods 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 χ2 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. Results 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). Conclusion 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.

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U2 - 10.1016/j.surg.2014.03.025

DO - 10.1016/j.surg.2014.03.025

M3 - Article

VL - 156

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EP - 197

JO - Surgery (United States)

JF - Surgery (United States)

SN - 0039-6060

IS - 1

ER -