Why aren't women in 30% of hospitals in Australia's capital cities having breast reconstruction following mastectomy for breast cancer? The role of the surgeon.
Association of Breast Surgery ePoster Library. Flitcroft K. 05/15/17; 166341; P140
Dr. Kathy Flitcroft
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Abstract
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Aim: Provision of post-mastectomy breast reconstruction (BR) in Australia has been associated with a range of factors, and the 'true' BR rate is uncertain. This article aims to clarify variation in BR rates between and within regions according to age, public/private hospital status and distance to travel for surgery.
Materials and methods: Data from the BreastSurgANZ Quality Audit (BQA) database and geospatial software were used to model the distribution of BR procedures performed on patients of BreastSurgANZ members in Australia in 2013. Geospatial mapping identified the distribution of procedures across states and their relationship to the Greater Capital City Statistical Areas (GCCSA) of the five largest states. Data were analysed using chi-squared tests of independence.
Results: De-identified data on 3,786 women was available. BR rates differed significantly (p<.001) between jurisdictions [χ2=164.90], being significantly higher in the GCCSA than non-GCCSA regions [χ2=144.60], and significantly higher for private hospitals than for public [χ2=50.72]. BR was not reported in 44% of hospitals where mastectomy was conducted by members of BreastSurgANZ, including 30% of hospitals within GCCSAs.
Conclusions: These data suggest significant variation in BR rates between hospitals in comparable location indicating variation is unlikely to be solely resource-driven. We hypothesise that surgeons' attitudes towards performing, or facilitating BR through referrals to experienced breast, plastic or oncoplastic surgeons, may also play an important role in explaining variation within GCCSAs. Improved access to more comprehensive quantitative hospital-level data and stakeholder input is required to further explore the reasons behind such regional variation in BR services.
Materials and methods: Data from the BreastSurgANZ Quality Audit (BQA) database and geospatial software were used to model the distribution of BR procedures performed on patients of BreastSurgANZ members in Australia in 2013. Geospatial mapping identified the distribution of procedures across states and their relationship to the Greater Capital City Statistical Areas (GCCSA) of the five largest states. Data were analysed using chi-squared tests of independence.
Results: De-identified data on 3,786 women was available. BR rates differed significantly (p<.001) between jurisdictions [χ2=164.90], being significantly higher in the GCCSA than non-GCCSA regions [χ2=144.60], and significantly higher for private hospitals than for public [χ2=50.72]. BR was not reported in 44% of hospitals where mastectomy was conducted by members of BreastSurgANZ, including 30% of hospitals within GCCSAs.
Conclusions: These data suggest significant variation in BR rates between hospitals in comparable location indicating variation is unlikely to be solely resource-driven. We hypothesise that surgeons' attitudes towards performing, or facilitating BR through referrals to experienced breast, plastic or oncoplastic surgeons, may also play an important role in explaining variation within GCCSAs. Improved access to more comprehensive quantitative hospital-level data and stakeholder input is required to further explore the reasons behind such regional variation in BR services.
Aim: Provision of post-mastectomy breast reconstruction (BR) in Australia has been associated with a range of factors, and the 'true' BR rate is uncertain. This article aims to clarify variation in BR rates between and within regions according to age, public/private hospital status and distance to travel for surgery.
Materials and methods: Data from the BreastSurgANZ Quality Audit (BQA) database and geospatial software were used to model the distribution of BR procedures performed on patients of BreastSurgANZ members in Australia in 2013. Geospatial mapping identified the distribution of procedures across states and their relationship to the Greater Capital City Statistical Areas (GCCSA) of the five largest states. Data were analysed using chi-squared tests of independence.
Results: De-identified data on 3,786 women was available. BR rates differed significantly (p<.001) between jurisdictions [χ2=164.90], being significantly higher in the GCCSA than non-GCCSA regions [χ2=144.60], and significantly higher for private hospitals than for public [χ2=50.72]. BR was not reported in 44% of hospitals where mastectomy was conducted by members of BreastSurgANZ, including 30% of hospitals within GCCSAs.
Conclusions: These data suggest significant variation in BR rates between hospitals in comparable location indicating variation is unlikely to be solely resource-driven. We hypothesise that surgeons' attitudes towards performing, or facilitating BR through referrals to experienced breast, plastic or oncoplastic surgeons, may also play an important role in explaining variation within GCCSAs. Improved access to more comprehensive quantitative hospital-level data and stakeholder input is required to further explore the reasons behind such regional variation in BR services.
Materials and methods: Data from the BreastSurgANZ Quality Audit (BQA) database and geospatial software were used to model the distribution of BR procedures performed on patients of BreastSurgANZ members in Australia in 2013. Geospatial mapping identified the distribution of procedures across states and their relationship to the Greater Capital City Statistical Areas (GCCSA) of the five largest states. Data were analysed using chi-squared tests of independence.
Results: De-identified data on 3,786 women was available. BR rates differed significantly (p<.001) between jurisdictions [χ2=164.90], being significantly higher in the GCCSA than non-GCCSA regions [χ2=144.60], and significantly higher for private hospitals than for public [χ2=50.72]. BR was not reported in 44% of hospitals where mastectomy was conducted by members of BreastSurgANZ, including 30% of hospitals within GCCSAs.
Conclusions: These data suggest significant variation in BR rates between hospitals in comparable location indicating variation is unlikely to be solely resource-driven. We hypothesise that surgeons' attitudes towards performing, or facilitating BR through referrals to experienced breast, plastic or oncoplastic surgeons, may also play an important role in explaining variation within GCCSAs. Improved access to more comprehensive quantitative hospital-level data and stakeholder input is required to further explore the reasons behind such regional variation in BR services.
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