4.4 Article

Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England

Journal

Publisher

ELSEVIER SCI LTD
DOI: 10.1016/j.bjps.2014.04.022

Keywords

Breast cancer; Mastectomy; Breast reconstruction; Outcomes; Quality of life; England

Categories

Funding

  1. Healthcare Quality Improvement Partnership

Ask authors/readers for more resources

Objectives: This paper summarises the findings of a national audit of mastectomy and breast reconstruction surgery carried out in England. It describes patterns of treatment, and the clinical and patient-reported quality of life outcomes associated with these types of procedure. Design: Prospective cohort study. Setting: All 150 National Health Service hospital groups (NHS trusts) in England that provided mastectomy or breast reconstruction surgery, along with six NHS trusts in Wales and Scotland and 114 independent hospitals. Participants: Women aged 16 years and over undergoing mastectomy with or without immediate breast reconstruction, or primary delayed breast reconstruction, between 1st January 2008 and 31st March 2009. Main outcome measures: Reconstructive utilisation, post-operative complications and sequelae, and patient-reported satisfaction and quality of life. Results: Overall, 21% of the 16,485 women who had mastectomy underwent immediate reconstruction. However, the proportion varied between regions from 9% to 43% (p < 0.001). Levels of patient satisfaction with information, choice and the quality of care were high. The proportion of women who experienced local complications was 10.30% (95% CI 9.78-10.84) for mastectomy surgery, ranged from 11.02% (9.31-12.92) to 18.24% (14.80-22.10) for different immediate reconstructive procedures, and from 5.00% (2.76-8.25) to 19.86% (16.21-23.94) for types of delayed reconstruction. Breast appearance and overall well-being scores reported 18 months after surgery were higher among women having immediate breast reconstruction compared to mastectomy only. Postoperative outcomes were similar across providers.. Conclusions: The Audit found women were highly satisfied with their peri-operative care, with hospital providers achieving similar outcomes. English providers should examine how to reduce the variation in rates of immediate reconstruction. (C) 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.4
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

Article Oncology

Determinants of variation in radical local treatment for men with high-risk localised or locally advanced prostate cancer in England

Matthew G. Parry, Jemma M. Boyle, Julie Nossiter, Melanie Morris, Arunan Sujenthiran, Brendan Berry, Paul Cathcart, Ajay Aggarwal, Jan van der Meulen, Heather Payne, Noel W. Clarke

Summary: This study found that there is significant variation in radical local treatment for high-risk localized or locally advanced prostate cancer among hospitals. This variation is primarily influenced by patient age and comorbidities, as well as socioeconomic deprivation and ethnicity, with older patients showing the highest level of variation.

PROSTATE CANCER AND PROSTATIC DISEASES (2023)

Article Oncology

Hospital volume and outcomes after radical prostatectomy: a national population-based study using patient-reported urinary continence and sexual function

Julie Nossiter, Melanie Morris, Thomas E. Cowling, Matthew G. Parry, Arunan Sujenthiran, Ajay Aggarwal, Heather Payne, Jan van der Meulen, Noel W. Clarke, Paul Cathcart

Summary: Increased radical prostatectomy volume does not have a significant association with longer-term functional outcomes. Hospitals in England already perform enough RP procedures to achieve satisfactory results.

PROSTATE CANCER AND PROSTATIC DISEASES (2023)

Article Oncology

Comparison of the treatment of men with prostate cancer between the US and England: an international population-based study

Matthew G. Parry, Julie Nossiter, Melanie Morris, Arunan Sujenthiran, Ted A. Skolarus, Brendan Berry, Arjun Nathan, Paul Cathcart, Ajay Aggarwal, Jan van der Meulen, Quoc-Dien Trinh, Heather Payne, Noel W. Clarke

Summary: There are differences in the treatment of prostate cancer between the United States and England, with US patients more likely to receive radical local treatment. This raises concerns of potential over-treatment for low-risk disease (CPG1) in the US and under-treatment of clinically significant disease (CPG3-5) in England.

PROSTATE CANCER AND PROSTATIC DISEASES (2023)

Article Dentistry, Oral Surgery & Medicine

Range and Frequency of Congenital Malformations Among Children With Cleft Lip and/or Palate

K. J. Fitzsimons, M. J. Hamilton, J. van der Meulen, J. Medina, M. A. H. Wahedally, M. H. Park, C. J. H. Russell

Summary: This study analyzed data from children receiving cleft care in English NHS hospitals between 2000 and 2012 and found that congenital malformations are common among children born alive with a cleft, affecting over half of some cleft subgroups.

CLEFT PALATE CRANIOFACIAL JOURNAL (2023)

Article Urology & Nephrology

Impact of centralization of prostate cancer services on the choice of radical treatment

Ajay Aggarwal, Lu Han, Alison Tree, Daniel Lewis, Tom Roques, Vijay Sangar, Jan van Der Meulen

Summary: This study assesses the impact of centralization of prostate cancer surgery and radiotherapy services on the choice of treatment for patients. The results show that the type of treatment received by patients is influenced by the relative proximity of treatment centers to their place of residence.

BJU INTERNATIONAL (2023)

Article Obstetrics & Gynecology

Iatrogenic and spontaneous preterm birth in England: A population-based cohort study

Harriet Aughey, Jennifer Jardine, Hannah Knight, Ipek Gurol-Urganci, Kate Walker, Tina Harris, Jan van der Meulen, Jane Hawdon, Dharmintra Pasupathy

Summary: This cohort study analyzed electronic health records to describe the rates and risk factors associated with iatrogenic and spontaneous preterm birth, as well as the variation in rates between different hospitals. The study found that just over half of all preterm births were iatrogenic and that iatrogenic and spontaneous sub-groups had different maternal demographic and clinical risk factors. There was also more variation between hospitals in rates of iatrogenic preterm births compared to spontaneous preterm births.

BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY (2023)

Letter Obstetrics & Gynecology

Authors' reply

Ipek Gurol-Urganci, Jennifer Jardine, Tina Harris, Asma Khalil, Jan van der Meulen

BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY (2023)

Article Gastroenterology & Hepatology

Outcomes after liver transplantation using deceased after circulatory death donors: A comparison of outcomes in the UK and the US

Tommy Ivanics, Marco P. A. W. Claasen, Madhukar S. S. Patel, Emmanouil Giorgakis, Shirin E. E. Khorsandi, Parthi Srinivasan, Andreas Prachalias, Krishna Menon, Wayel Jassem, Miriam Cortes, Blayne A. A. Sayed, Amit K. K. Mathur, Kate Walker, Rhiannon Taylor, Nigel Heaton, Neil Mehta, Dorry L. L. Segev, Allan B. B. Massie, Jan H. P. van Der Meulen, Gonzalo Sapisochin, David Wallace

Summary: Comparing the utilization and outcomes of DCD LT between the UK and the US provides insights into the international differences. The study found that although the use of DCD livers increased in both countries, the long-term transplant outcomes in the UK were superior to those in the US.

LIVER INTERNATIONAL (2023)

Article Surgery

Association of Quality and Technology With Patient Mobility for Colorectal Cancer Surgery

Ajay Aggarwal, Lu Han, Jemma Boyle, Daniel Lewis, Angela Kuyruba, Michael Braun, Kate Walker, Nicola Fearnhead, Richard Sullivan, Jan Van Der Meulen

Summary: This study investigated factors associated with cancer patients' choice of treatment location. The results showed that travel time was strongly associated with treatment location. The association was weaker for younger, more affluent patients and those from rural areas. For rectal cancer patients, they were more likely to travel to hospitals designated as specialist colorectal cancer surgery centers and hospitals performing robotic surgery for rectal cancer. Patients were less likely to travel to hospitals deemed to have inadequate care by the national quality regulator. Patients were not more likely to travel to hospitals with better 2-year bowel cancer mortality outcomes.

JAMA SURGERY (2023)

Editorial Material Obstetrics & Gynecology

Use of Induction of Labour and Emergency Cesarean Section and Perinatal Outcomes in English Maternity Services: A National Hospital-Level Study

Ipek Gurol-Urganci, Jennifer Jardine, Fran Carroll, Alissa Fremeaux, Patrick Muller, Sophie Relph, Lara Waite, Kirstin Webster, Sam Oddie, Jane Hawdon, Tina Harris, Asma Khalil, Jan van der Meulen

Summary: The provision of care in maternity services requires a delicate balance between supporting the natural process of childbirth and clinical interventions when necessary. However, there is a lack of consensus on clinical guidelines for maternity care, leading to significant variations in induction of labor and cesarean delivery rates between hospitals in the United Kingdom. This study aimed to examine the association between rates of induction of labor and emergency cesarean delivery with adverse perinatal outcomes.

OBSTETRICAL & GYNECOLOGICAL SURVEY (2023)

Article Medicine, General & Internal

Number and timing of primary cleft lip and palate repair surgeries in England: whole nation study of electronic health records before and during the COVID-19 pandemic

David Etoori, Min Hae Park, Ruth Marion Blackburn, Kate J. Fitzsimons, Sophie Butterworth, Jibby Medina, Louise Mc Grath-Lone, Craig Russell, Jan van der Meulen

Summary: This study observed a significant reduction in the number and delays in timing of first primary cleft lip and palate repair procedures in England during the first year of the COVID-19 pandemic. The number of procedures decreased by 17.8%, and the timing of the surgeries was delayed by an average of 1.6 months.

BMJ OPEN (2023)

Article Oncology

Treatment-related toxicity using prostate bed versus prostate bed and pelvic lymph node radiation therapy following radical prostatectomy: A national population-based study

Arunan Sujenthiran, Matthew G. Parry, Joanna Dodkins, Julie Nossiter, Melanie Morris, Brendan Berry, Arjun Nathan, Paul Cathcart, Noel W. Clarke, Heather Payne, Jan van der Meulen, Ajay Aggarwal

Summary: This study compared the toxicity of radiation therapy to the prostate bed and pelvic lymph nodes with radiation therapy to the prostate bed only in patients with recurrent prostate cancer following radical prostatectomy. The results showed no significant difference in gastrointestinal and genitourinary toxicity between the two treatment strategies at 5 years.

CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY (2023)

Article Medicine, General & Internal

Induction of labour at 39 weeks and adverse outcomes in low-risk pregnancies according to ethnicity, socioeconomic deprivation, and parity: A national cohort study in England

Patrick Muller, Amar M. Karia, Kirstin Webster, Fran Carroll, George Dunn, Alissa Fremeaux, Tina Harris, Hannah Knight, Sam Oddie, Asma Khalil, Jan van der Meulen, Ipek Gurol-Urganci

Summary: This study analyzed a database of maternity admissions in the English National Health Service (NHS) to investigate the association between induction of labor (IOL) at 39 weeks and adverse perinatal outcomes in low-risk pregnancies. The researchers found evidence that IOL in low-risk pregnancies can lead to a small reduction in adverse perinatal outcomes, with 360 inductions associated with the avoidance of 1 adverse outcome. The benefits of induction were observed mainly in women from socioeconomically deprived areas and nulliparous women.

PLOS MEDICINE (2023)

Article Orthopedics

Outcomes in Ankle Replacement Study (OARS) RADIOLOGICAL AND PATIENT- REPORTED OUTCOMES IN THE FIRST 12 MONTHS AFTER ANKLE ARTHROPLASTY

T. O. Smith, J. Dainty, D. T. Loveday, A. Toms, A. J. Goldberg, L. Watts, M. W. Pennington, J. Dawson, J. van der Meulen, A. J. MacGregor

Summary: This study aimed to investigate the 12-month outcomes of patients undergoing total ankle arthroplasty (TAA) and analyze the predictors of these outcomes. The results showed significant improvements in patient-reported outcome measures (PROMs) at 6 and 12 months after TAA compared to preoperative scores. The study also found that the most improvement occurred between preoperative and 6 months postoperative, with little further improvement at 12 months. Older age and more advanced radiological signs of ankle osteoarthritis at baseline were associated with greater improvements in PROMs. These findings provide important information for counseling younger patients and those with earlier ankle disease on the expectations of TAA.

BONE & JOINT JOURNAL (2023)

Letter Surgery

Anthropometric analysis of the external nose of the Indonesian females: A basic data to achieve good nasal reconstruction

Arif Tri Prasetyo, Lisa Y. Hasibuan, Kevin Leonard Suryadinata

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Article Surgery

Trigeminal or peripheral nerve stimulation improves functional outcomes of nerve recovery in a rodent forelimb gap repair model

Peter J. Nicksic, D'Andrea T. Donnelly, Weifeng Zeng, Allison J. Seitz, Samuel O. Poore, Aaron J. Suminski, Aaron M. Dingle

Summary: The study demonstrates that trigeminal nerve stimulation (TNS) or peripheral nerve stimulation (PNS) can improve functional outcomes of peripheral nerve injury in rats. This finding is important in translating the therapy as a non-invasive treatment for high, mixed nerve injuries in humans.

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Article Surgery

Restoring the spontaneous smile through free functional muscle transfer. A systematic review and meta-analysis of the last twenty years' experience

K. Can Bayezid, Suat Morkuzu, Erdem Karabulut, Adam Bajus, Libor Streit

Summary: This study compared the spontaneity outcomes of the most preferred neurotization methods in facial reanimation surgery. The results showed that dual innervation and contralateral facial nerve-driven strategies achieved the most promising outcomes, while motor nerve to the masseter had lower potential to elicit spontaneous smile.

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Letter Surgery

GPT-4 and plastic surgery inservice training examination

Hinpetch Daungsupawong, Viroj Wiwanitkit

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Article Surgery

Psychological evaluation of Asian female patients with rhinoplasty

Zidi Yu, Ziwei Zhang, Xiancheng Wang, Dandan Song, Quanding Yan, Yang Sun, Xiang Xiong, Xianxi Meng, Wenbo Li, Zhongjie Yi

Summary: Pathological psychologies such as anxiety, depression, and body dysmorphic disorder (BDD) are common in female patients scheduled to undergo rhinoplasty. BDD is more likely to be associated with depression. Rhinoplasty has little psychological impact on patients, but female patients with BDD are more likely to be dissatisfied with the surgery.

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Article Surgery

Assessing safety and efficacy of microscopic and laparoscopic varicocoelectomy for varicocoele treatment: A comparative cohort study

Lei Wang, Qian Zhu, Yuanyuan Zhang, Yulin Miao, Huan Liu, Fengli Gao

Summary: This comparative observational study found that microscopic varicocoelectomy had higher sperm motility and showed significant improvements in certain postoperative parameters compared to laparoscopic varicocoelectomy. Neither group experienced testicular atrophy.

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Article Surgery

Managing complications following cosmetic surgery after the COVID pandemic: A study of a year at an NHS plastic surgery unit

Mohamed Dalmar, Mohamed El Sheikh, Richard Baker, Rajan Uppal

Summary: This study analyzed complications following cosmetic surgeries managed by plastic surgery services at Heatherwood and Wexham Park hospitals in 2022, including procedures performed internationally. The majority of complications were related to breast cosmetic surgery and abdominoplasties, with the most common complications being wound dehiscence, post-operative infection, and seromas. Turkey was the most popular country selected for surgery, and there is a need to increase public awareness of the risks involved in seeking international options and how to choose suitable clinics.

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Editorial Material Surgery

Reply to commentary on GPT-4 and plastic surgery inservice training examination

Rohun Gupta, Lawson E. Spence, Peter K. Firouzbakht, Brian A. Mailey

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Article Surgery

Outcome analysis and assessment of the lower pole expansion following breast augmentation with ergonomic implants: Optimizing results with patient selection based on 5-year data

Alexandre Mendonca Munhoz, Ary de Azevedo Marques Neto, Joao Maximiliano, Murillo Fraga

Summary: This study investigated the outcomes of silicone implants in breast augmentation and found that ergonomic style implants can achieve favorable results with lower complication rates.

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Article Surgery

Oncoplastic breast reduction surgery decreases rates of reoperation with no increased medical risk

Lee H. Kilmer, Allan A. Weidman, Brent R. Degeorge, John T. Stranix, Chris A. Campbell

Summary: The study aims to compare the oncologic, medical, and surgical outcomes of lumpectomy and oncoplastic breast reduction surgery (OBRS) on a national scale. A database was used to analyze patient data and match them based on various factors. The results showed that lumpectomy patients had higher rates of repeat lumpectomy or subsequent mastectomy, while OBRS patients had higher rates of surgical complications but fewer medical complications. Logistic regression analysis revealed that OBRS was associated with a decreased likelihood of repeat lumpectomy. Although OBRS was associated with increased wound complications, medical complications were found to occur less frequently.

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Review Surgery

Review Indications, outcomes, and complications of neoumbilical reconstruction: A systematic review

M. Guiotto, C. M. Oranges, M. Cherubino, M. Maruccia, P. Tedeschi, D. F. Kalbermatten, W. Raffoul, P. G. di Summa

Summary: This study evaluated different surgical approaches for neoumbilicoplasty and correlated them with specific surgical needs. The results showed that direct suture, single flap, and multiple flap techniques can achieve overall satisfactory cosmetic outcomes with a low rate of surgical complications. Different surgical techniques are suitable for different patient populations and surgical scenarios.

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Review Surgery

Modern Machiavelli? The illusion of ChatGPT-generated patient reviews in plastic and aesthetic surgery based on 9000 review classifications

Samuel Knoedler, Giuseppe Sofo, Barbara Kern, Konstantin Frank, Sebastian Cotofana, Sarah von Isenburg, Soren Konneker, Francesco Mazzarone, Amir H. Dorafshar, Leonard Knoedler, Michael Alfertshofer

Summary: This study compared real patient feedback with ChatGPT-generated reviews for the top five US plastic surgery procedures. It found that analyzing the emotional tone and review length can help differentiate real from fake reviews, and ChatGPT-generated reviews can convincingly deceive commercial AI detection software.

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Article Surgery

Optimal surgical timing for ear reconstruction with autologous cartilage: Analysis of the computed tomography scan characteristics of the ribs

Gerlya Asirova, Jan Wynands, Sergey Frolov, Diana Almeida, Pavel Davydenko, Salem Madina

Summary: By assessing the development and growth of costal cartilage, the optimal age for ear reconstruction surgery in the Russian population was determined to be 10 years and older.

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Letter Surgery

Letter to the Editor: Subdermal contraceptive implant-related neuropathy of the upper limb: A time for change

S. Curran, E. Heffernan, S. Connolly, K. Levins, K. Cronin, R. Dolan

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)

Article Surgery

Non-vascularised corticocancellous (tricortical) iliac bone graft longer than 3 cm for non-union after failed surgical treatment

Soo Min Cha, Ashwin Pai, Hyun Jong Lee, Hyun Dae Shin

Summary: In this retrospective case series, we found that non-vascularized iliac bone graft longer than 3 cm had satisfactory clinical outcomes in the treatment of non-union of the upper extremities.

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (2024)