El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson WMorbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg 245: 665-671

New York Presbyterian Hospital at Columbia University Department of Surgery, 161 Fort Washington Avenue, New York, NY 10032, USA.
Annals of Surgery (Impact Factor: 8.33). 05/2007; 245(5):665-71. DOI: 10.1097/01.sla.0000245833.48399.9a
Source: PubMed


Most reports on postoperative (OP) morbidity and mortality following breast cancer surgery (BCS) are limited by relatively small sample size resulting in a lack of national benchmarks for quality of care. This paper reports the 30-day morbidity and mortality following BCS in women using a large prospective multi-institutional database.
The National Surgical Quality Improvement Program Patient Safety in Surgery, prospectively collected inpatient and outpatient 30 day postoperative morbidity and mortality data on patients undergoing surgery at 14 university and 4 community centers. Using the procedure CPT code, the database was queried for all women undergoing mastectomy (MT) or lumpectomy with an axillary procedure (L-ANP). Morbidity and mortality were categorized as mortality, wound, cardiac, renal, pulmonary, and central nervous system. Logistic regression models for the prediction of wound complications were developed. Preoperative variables having bivariate relationships with postoperative wound complications with P < or = 0.20 were submitted for consideration.
We identified 1660 and 1447 women who underwent MT and l-ANP, respectively. The mean age was 55.9 years. The majority of procedures were under general anesthesia. The 30-day postoperative mortality for MT and l-ALNP were 0.24% and 0%, respectively. The most frequent morbid complication was wound infection, more commonly occurring in the mastectomy (4.34%) group versus the lumpectomy group (1.97%). Cardiac and pulmonary complications occurred infrequently in the mastectomy group (cardiac: MT, 0.12%; and pulmonary: MT, 0.66%). There were no cardiac or pulmonary complications in the lumpectomy group. CNS morbidities were rare in both surgical groups (MT, 0.12%; and l-ALNP, 0.07%). Development of a UTI was more common in women who underwent a mastectomy (0.66%) when compared with women that had a lumpectomy (0.14%). The only significant predictors of a wound complication were morbid obesity (BMI >30), having had a MT, low preoperative albumin and hematocrit greater than 45%.
Morbidity and mortality rates following BCS in women are low, limiting their value in assessing quality of care. Mastectomy carries higher complication rate than l-ANP with wound infection being the most common.

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    • "Please cite this article in press as: Unukovych D, et al., Physical therapy after prophylactic mastectomy with breast reconstruction: A prospective randomized study, The Breast (2014), summated scores 0e7 represent non-cases (normal), 8e10 possible clinical cases, and 11e21 represent clinical levels of anxiety and depression [18]. " Pain/motion/sensation scale " . "
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    • "And, as with our efforts in lower extremity revascularization, another role for risk prediction models is to allow comparison of risk-adjusted outcomes among different centers. An important element in surgical quality improvement is to establish benchmarks for performance [79–82]. Most outcome benchmarks require risk adjustment, to account for potential differences in patient populations that could influence outcomes [83], and multivariate risk prediction models are developed to account for differences in patient characteristics when comparing outcomes [84, 85]. "
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