Does a breast cancer surgery patient's likelihood of enduring a second surgery, called reexcision, vary depending on her choice of hospital and surgeon, as opposed to her clinical profile? And could this lead to unnecessary surgeries?
Apparently, yes, according to a study of 2,206 patients by researchers who found substantial variation in four institutions in reexcision rates for patients who had negative specimen margins after the initial surgery.
The hospitals were not identified by result, but they included the University of Vermont and three health plans, Kaiser Permanente Colorado, Group Health of western Washington State and Marshfield Clinic of Wisconsin.
"Reexcision rates for patients with initial negative margins varied by institution, from a low of 1.7% ... at institution D, compared with 20.9% ...institution B." And among surgeons, the rate varied between 0% and 70%.
But whether that is a significant quality metric that should be studied for widespread adoption remains unclear, the researchers, led by Laurence McCahill, MD of the University of Michigan, wrote in their study, published in today's edition of the Journal of the American Medical Association.