The National Mastectomy and Breast
Reconstruction Audit
Key findings of the Third Annual Report
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Audit aims
• To describe provision of mastectomy and breast
reconstruction services in England
• To investigate determinants and outcomes of
care for women with breast cancer having a
mastectomy with or without breast
reconstruction
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Audit methodology
• The Audit prospectively enrolled
–
–
–
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women with breast cancer
who underwent mastectomy or breast reconstruction surgery
in the NHS and independent sector in England
between 1 January 2008 and 31 March 2009
• Data collected by
– clinicians on clinical practice and inpatient outcomes
– patients on treatment options, patient-reported outcomes and
experience of care
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Audit participation – clinical study
• 18,216 women with complete information:
– 16,558 treated at English NHS trusts
– 1,249 treated at independent hospitals
– 409 treated at non-English NHS trusts that also chose to
participate
• Overall NHS case ascertainment of 81.4%
• More than two thirds of NHS trusts had over 75% case
ascertainment
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Audit participation – PROMs study
• 10,521 women asked to participate in patientreported outcome measures (PROMs) study
– 8,636 (82%) gave their consent
• 8,159 women sent questionnaires
– 6,882 (84%) returned a completed questionnaire
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Third Annual Report
Provides information on:
• Patient characteristics, treatment and inpatient
outcomes
• Patient-reported experience of care and post-discharge
complications, collected 3-months after surgery
• Results presented by type of surgery
– mastectomy only, mastectomy with immediate
reconstruction, and delayed reconstruction
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Providing reconstructive information
and choice
• Among women having immediate or delayed reconstruction,
– 90% felt that they got the right amount of information about their surgery
• Among women having mastectomy-only
– 91% felt that they got the right amount of information about their surgery
– 65% felt that they got the right amount of information about breast
reconstruction
• 8% of mastectomy-only women stated that a lack of local
availability was one of the reasons why they did not have
immediate reconstruction
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Recommendation 1
•
Clinicians should act to better inform women about
both the procedures they decide to undergo and the
reconstructive options available.
•
As per the 2009 NICE guidance, clinicians should
ensure that women are offered a full range of
appropriate reconstructive options, whether or not
these are available locally.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Providing appropriate pain relief
• In 1997, the Audit Commission recommended that less
than 5% of patients should report experiencing severe
postoperative pain
• 6.2% of mastectomy-only patients experienced severe
pain in the first 24 hours
• 16.5% of immediate and 20.1% of delayed
reconstruction patients experienced severe pain in the
first 24 hours
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Recommendation 2
•
NHS trusts and independent hospitals should
ensure that women understand how to report
their levels of pain and access appropriate
pain relief, and that they are provided with
adequate psychological support following their
surgery.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
High levels of patient satisfaction
• Women undergoing mastectomy and breast reconstruction rated
the care they received very highly
• Overall quality of care was rated as excellent by
– 66% of mastectomy-only patients
– 72% of immediate & 74% of delayed reconstruction patients
• In comparison, 43% of patients in 2008 NHS inpatient survey
rated their quality of care as excellent
• Over 85% of women said they were always treated with respect
and dignity
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Recommendation 3
•
NHS trusts and independent hospitals should
continue to monitor patients’ experience with
care and act to maintain the high levels of
satisfaction reported.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Using data to inform patients
• Serious inpatient complications after surgery are rare
• However:
– One in ten women had an inpatient complication
– One in ten mastectomy-only patients and one in six
reconstruction patients was readmitted for unplanned
treatment or surgery after their primary admission
– One in five mastectomy-only patients and one in four
reconstruction patients required antibiotic treatment for a
suspected wound infection post-discharge
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Recommendation 4
•
Clinicians should use the data on inpatient and
postoperative complications to inform women about
risks of different operations.
•
Women considering reconstruction should be
informed pre-operatively that the chance of requiring
further surgery either during their initial admission or
postoperatively is around one in ten.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Benchmarking using the national results
• Organisational complication rates were published for:
– Returned to theatre,
– Mastectomy site complications
– Distant or systemic complication
• Risk-adjusted complication rates for the organisations
were within the range expected
• Some organisations were excluded due to low caseascertainment or incomplete outcomes data
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Recommendation 5
•
Multidisciplinary teams at NHS trusts and
independent hospitals should review the
outcomes of their own patients and compare
them with the national outcomes described in
this report to ensure that they are delivering a
high quality of care.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Informing future guidelines
• The Audit represents the first national
prospective study of women undergoing
mastectomy and breast reconstruction surgery
• The clinician and patient-reported data collected
during the Audit has expanded the evidence
base, and its findings should be used to refine
both local and national guidelines
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Recommendation 6
• The Surgical Associations and Royal Colleges
involved in mastectomy and breast
reconstruction surgery should consider issuing
new guidance on patient selection, operative
techniques and postoperative care.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Fourth Annual Report
• This will include:
– Data on women’s quality of life 18 months after surgery
– National comparative analyses of key patient-reported
outcome measures
– Validation of clinician-reported national and local inpatient
complication rates by linking audit data to Hospital Episode
Statistics records
• The report will be published in March 2011
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Thank you!
Please e-mail mbr@ic.nhs.uk or rjeevan@rcseng.ac.uk
or call 0113 254 7139
for copies of any of the Audit reports
or if you have any queries
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010