Hospital organizational factors affect the use of immediate breast reconstruction after mastectomy for breast cancer in the Netherlands |
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| Affiliation: | 1. Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands;2. Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands;3. Scientific Committee NABON Breast Cancer Audit (NBCA), The Netherlands;4. Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands;5. Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands;6. Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;7. Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute/University Medical Centre Rotterdam, Rotterdam, The Netherlands;1. Department of Surgical Oncology, Gelderse Vallei Hospital, Ede, The Netherlands;2. Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands;3. Department of Plastic Surgery, VU University Medical Center, Amsterdam, The Netherlands;4. Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands;5. Department of Epidemiology and Biostatistics, NKI-AVL, Amsterdam, The Netherlands;1. Department of Pediatric Surgery, Monroe Carell Jr. Children''s Hospital at Vanderbilt, Nashville, Tennessee;2. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee;3. Department of Pediatrics, Monroe Carell Jr. Children''s Hospital at Vanderbilt, Nashville, Tennessee;1. Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands;2. Dutch Institute for Clinical Auditing, Leiden, The Netherlands;3. Department of Surgery, OLVG, Amsterdam, The Netherlands;4. Department of Clinical Epidemiology, OLVG, Amsterdam, The Netherlands;5. Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands;6. Department of Surgery, Deventer Hospital, Deventer, The Netherlands;7. Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands;8. Faculty of Technical Sciences, University of Twente, Enschede, The Netherlands;9. Department of Surgery, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;10. Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands;1. Ariadne Labs, Brigham and Women''s Hospital, Harvard. T.H. Chan School of Public Health, Boston, MA, USA;2. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA;3. Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA |
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| Abstract: | ObjectivesSignificant hospital variation in the use of immediate breast reconstruction (IBR) after mastectomy exists in the Netherlands. Aims of this study were to identify hospital organizational factors affecting the use of IBR after mastectomy for ductal carcinoma in situ (DCIS) or invasive breast cancer (BC) and to analyze whether these factors explain the variation.Materials and methodsPatients with DCIS or primary invasive BC treated with mastectomy between 2011 and 2013 were selected from the national NABON Breast Cancer Audit. Hospital and organizational factors were collected with an online web-based survey. Regression analyses were performed to determine whether these factors accounted for the hospital variation.ResultsIn total, 78% (n = 72) of all Dutch hospitals participated in the survey. In these hospitals 16,471 female patients underwent a mastectomy for DCIS (n = 1,980) or invasive BC (n = 14,491) between 2011 and 2014. IBR was performed in 41% of patients with DCIS (hospital range 0–80%) and in 17% of patients with invasive BC (hospital range 0–62%). Hospital type, number of plastic surgeons available and attendance of a plastic surgeon at the MDT meeting increased IBR rates. For invasive BC, higher percentage of mastectomies and more weekly MDT meetings also significantly increased IBR rates. Adjusted data demonstrated decreased IBR rates for DCIS (average 35%, hospital range 0–49%) and invasive BC (average 15%, hospital range 0–18%).ConclusionHospital organizational factors affect the use of IBR in the Netherlands. Although only partly explaining hospital variation, optimization of these factors could lead to less variation in IBR rates. |
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| Keywords: | Hospital variation Mastectomy Hospital organizational factors Breast reconstruction Breast cancer Audit |
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