Departments of Surgery, 5755Yale University, New Haven, CT, USA.
12279Wake Forest University, Winston-Salem, North Carolina.
Am Surg. 2022 Apr;88(4):648-652. doi: 10.1177/00031348211054714. Epub 2021 Nov 3.
We sought to determine factors affecting time to surgery (TTS) to identify potential modifiable factors to improve timeliness of care.
Patients with clinical stage 0-3 breast cancer undergoing partial mastectomy in 2 clinical trials, conducted in ten centers across the US, were analyzed. No preoperative workup was mandated by the study; those receiving neoadjuvant therapy were excluded.
The median TTS among the 583 patients in this cohort was 34 days (range: 1-289). Patient age, race, tumor palpability, and genomic subtype did not influence timeliness of care defined as TTS ≤30 days. Hispanic patients less likely to have a TTS ≤30 days ( = .001). There was significant variation in TTS by surgeon ( < .001); those practicing in an academic center more likely to have TTS ≤30 days than those in a community setting (55.1% vs 19.3%, < .001). Patients who had a preoperative ultrasound had a similar TTS to those who did not (TTS ≤30 days 41.9% vs 51.9%, respectively, = .109), but those who had a preoperative MRI had a significantly increased TTS (TTS ≤30 days 25.0% vs 50.9%, < .001). On multivariate analysis, patient ethnicity was no longer significantly associated with TTS ≤30 ( = .150). Rather, use of MRI (OR: .438; 95% CI: .287-.668, < .001) and community practice type (OR: .324; 95% CI: .194-.541, < .001) remained independent predictors of lower likelihood of TTS ≤30 days.
Preoperative MRI significantly increases time to surgery; surgeons should consider this in deciding on its use.
我们旨在确定影响手术时间（TTS）的因素，以确定潜在的可改变因素，从而提高治疗的及时性。
分析了在美国十个中心进行的两项临床试验中接受部分乳房切除术的 0-3 期临床阶段乳腺癌患者。该研究没有规定术前检查；排除接受新辅助治疗的患者。
在该队列的 583 名患者中，中位数 TTS 为 34 天（范围：1-289）。患者年龄、种族、肿瘤可触知性和基因组亚型对定义为 TTS≤30 天的护理及时性没有影响。西班牙裔患者 TTS≤30 天的可能性较低（=0.001）。外科医生之间的 TTS 存在显著差异（<0.001）；在学术中心工作的外科医生比在社区环境中工作的外科医生更有可能 TTS≤30 天（55.1%比 19.3%，<0.001）。接受术前超声检查的患者与未接受超声检查的患者 TTS 相似（TTS≤30 天分别为 41.9%和 51.9%，=0.109），但接受术前 MRI 检查的患者 TTS 显著增加（TTS≤30 天分别为 25.0%和 50.9%，<0.001）。多变量分析显示，患者种族与 TTS≤30 天不再显著相关（=0.150）。相反，MRI 的使用（OR：0.438；95%CI：0.287-0.668，<0.001）和社区实践类型（OR：0.324；95%CI：0.194-0.541，<0.001）仍然是 TTS≤30 天可能性降低的独立预测因素。
术前 MRI 显著增加手术时间；外科医生在决定使用 MRI 时应考虑这一点。
