P16 Measuring the quality of breast surgery in Australia & New Zealand: How do we rate?

Abstract

Aim To evaluate members’ compliance at suggested threshold recommendation rates for 4 evaluable High-Quality Practice Indicators (HQPIs) introduced by BreastSurgANZ to improve patient care. To benchmark our standards against global best practice. Method Using BreastSurgANZ Quality Audit data 2012-2016 & 2018 rates of attainment for HQPI’s were documented including results for different volume surgeons. Outcomes where compared to international standards. Results If the threshold rate was set at > 40% of a surgeon’ patients having immediate breast reconstruction (IBR) for in situ cancer requiring mastectomy, of 3761 cases, 30% of all members and 78% for very high-volume surgeons achieved that rate; 40% is comparable to international recommendations. If the threshold was set at >20% IBR for invasive breast cancer requiring mastectomy, of 26,007 cases evaluated 28% of all surgeons and 78% for very high-volume surgeons met the standard. 20% is below most international recommendations. If the threshold was set at >70% of a surgeon’s cases having breast conservation for tumours < 2 cm, from 31,698 cases evaluated, 64% of all surgeons and 89% for very high-volume surgeons met the standard; 70% is comparable to international recommendations. If the threshold rate for use of neoadjuvant chemotherapy was set at >15% in women <50 years old, of 1382 patients evaluated in 2018, 36% of all surgeons complied; 15% is below most international recommendations. Conclusions HQPI’s are an important and evaluable way to standardise patient care. Our current Breast SURGANZ HQPI’s and the established thresholds are either comparable or somewhat lower than globally accepted standards. Members must continue towards achieving these standards, particularly regarding IBR and neoadjuvant chemotherapy, with many high-volume surgeons already likely to comply.