Ikazia Hospital, Rotterdam, The Netherlands.
Eur J Surg Oncol. 2011 Apr;37(4):357-63. doi: 10.1016/j.ejso.2011.01.008. Epub 2011 Feb 2.
Re-resection rate after breast-conserving surgery (BCS) has been introduced as an indicator of quality of surgical treatment in international literature. The present study aims to develop a case-mix model for re-resection rates and to evaluate its performance in comparing results between hospitals.
Electronic records of eligible patients diagnosed with in-situ and invasive breast cancer in 2006 and 2007 were derived from 16 hospitals in the Rotterdam Cancer Registry (RCR) (n = 961). A model was built in which prognostic factors for re-resections after BCS were identified and expected re-resection rate could be assessed for hospitals based on their case mix. To illustrate the opportunities of monitoring re-resections over time, after risk adjustment for patient profile, a VLAD chart was drawn for patients in one hospital.
In general three out of every ten women had re-surgery; in about 50% this meant an additive mastectomy. Independent prognostic factors of re-resection after multivariate analysis were histological type, sublocalisation, tumour size, lymph node involvement and multifocal disease. After correction for case mix, one hospital was performing significantly less re-resections compared to the reference hospital. On the other hand, two were performing significantly more re-resections than was expected based on their patient mix.
Our population-based study confirms earlier reports that re-resection is frequently required after an initial breast-conserving operation. Case-mix models such as the one we constructed can be used to correct for variation between hospitals performances. VLAD charts are valuable tools to monitor quality of care within individual hospitals.
保乳手术后的再次切除率已被引入国际文献作为手术治疗质量的指标。本研究旨在建立一个再次切除率的病例组合模型，并评估其在比较医院间结果方面的性能。
从鹿特丹癌症登记处（RCR）的 16 家医院获得了 2006 年和 2007 年诊断为原位和浸润性乳腺癌的合格患者的电子记录（n=961）。建立了一个模型，确定了保乳手术后再次切除的预测因素，并可以根据医院的病例组合评估其预期再次切除率。为了说明随着时间的推移对再次切除进行监测的机会，在对患者特征进行风险调整后，为一家医院的患者绘制了 VLAD 图表。
总体而言，每 10 名女性中有 3 名接受了再次手术；其中约 50%是附加的乳房切除术。多因素分析后的独立再次切除预测因素是组织学类型、亚局部化、肿瘤大小、淋巴结受累和多灶性疾病。在病例组合校正后，与参考医院相比，一家医院的再次切除率明显较低。另一方面，有两家医院的再次切除率明显高于根据其患者组合预期的切除率。
我们的基于人群的研究证实了早期报告，即初始保乳手术后经常需要再次切除。病例组合模型，如我们所构建的模型，可以用于校正医院间表现的差异。VLAD 图表是监测单个医院护理质量的有用工具。
