Aim:
To establish and apply a suite of breast cancer surgery indicators to administrative health data to track surgical practice in breast cancer care services for Queensland (Qld) hospitals.
Methods:
The Qld Oncology Repository (QOR) compiles and collates administrative and clinical data from the Qld Cancer Registry together with hospital admissions, treatment and mortality data. Eight surgical practice indicators were applied to examine and compare surgical practice and timeliness of surgery in Qld hospitals for women diagnosed with invasive breast cancer between 2010 and 2014.
Results:
Breast cancer surgery was performed in over 70 public and private hospitals in Qld with a range between 1 and 290 definitive procedures annually. Compared with the Qld average there was significant variation in adjusted rates over the breast cancer surgery indicators, when analysed by individual hospital, comparable hospital groupings and public and private hospitals. The definitive mastectomy rate for all breast cancers was 44% and the initial mastectomy rate for T1 tumours was 23%. The re-excision rate after breast conserving surgery (BCS) was 20% and the conversion rate of initial BCS to mastectomy was 15%. The sentinel lymph node biopsy rate for T1 tumours with initial BCS was 87%, with the majority of hospitals exceeding the Qld average. Radiotherapy was delivered to 87% of patients following BCS. The proportion of women receiving surgery within 45 days from histological diagnosis was higher in private hospitals (93%) compared with public hospitals (80%). 68% of Qld women receiving subsequent definitive breast cancer surgery waited less than 21 days from their initial surgery.
Conclusions:
State-wide audit and comparison of surgical practice across Qld facilities provide surgeons, clinical teams and management with the opportunity to review clinical practice and processes, highlighting variation in surgical practice and identifying areas for improvement.