Quality indicators in breast cancer surgery

Introduction: Although clear guidelines for breast cancer management have been developed and widespread, there are many variations between centers and even among breast cancer surgeons, with impact in clinical outcomes. Use of quality indicators to assess surgical care allows comparison with standards and with other centers and monitoring changes post intervention. Objective: To apply quality indicators to breast cancer surgery and evaluate usefulness. Material and Methods: Selected indicators obtained from EUSOMA 2008 workshop were applied to 213 consecutive surgical treatment breast cancer patients from Hospital Militar de Santiago de Chile between 2006 and 2011, comparing results with previously defined standards. Results: Benign/malignant index in surgical biopsies: 1: 2.27 (minimum standard: 1/2; Optimum: 1/4), patients with complete pathologic report percentage: 99,2% (minimum: 95%, optimum: 98%), breast conserving surgery percentage: 80.20% (minimum: 70%, optimum: 80%), patients with sufficient axillary sampling percentage: 92.4% (minimum: 95%, optimum: 98%), correct axillary dissection indication percentage: 100% (minimum: 95%, optimum: 98%) and patients who underwent single surgery percentage: 90.40% (minimum: 80%, optimum: 90%), most of them ranged between established standards. Conclusion: The use of quality indicators allows breast cancer surgery result evaluation, enabling comparison between centers and established standards, giving objective and reproducible information, helpful to plan process optimization. These or similar indicators are useful in all breast cancer treatment steps and for breast cancer unit accreditation processes. Our indicator values that are under the standard reveal that some specific local indicators are required.