Changes in and predictors of length of stay in hospital after surgery for breast cancer between 1997-98 and 2004-05 in two regions of England: a population-based studyReport as inadecuate




Changes in and predictors of length of stay in hospital after surgery for breast cancer between 1997-98 and 2004-05 in two regions of England: a population-based study - Download this document for free, or read online. Document in PDF available to download.

BMC Health Services Research

, 9:202

First Online: 09 November 2009Received: 04 August 2009Accepted: 09 November 2009DOI: 10.1186-1472-6963-9-202

Cite this article as: Downing, A., Lansdown, M., West, R.M. et al. BMC Health Serv Res 2009 9: 202. doi:10.1186-1472-6963-9-202

Abstract

BackgroundDecreases in length of stay LOS in hospital after breast cancer surgery can be partly attributed to the change to less radical surgery, but many other factors are operating at the patient, surgeon and hospital levels. This study aimed to describe the changes in and predictors of length of stay LOS in hospital after surgery for breast cancer between 1997-98 and 2004-05 in two regions of England.

MethodsCases of female invasive breast cancer diagnosed in two English cancer registry regions were linked to Hospital Episode Statistics data for the period 1 April 1997 to 31 March 2005. A subset of records where women underwent mastectomy or breast conserving surgery BCS was extracted n = 44,877. Variations in LOS over the study period were investigated. A multilevel model with patients clustered within surgical teams and NHS Trusts was used to examine associations between LOS and a range of factors.

ResultsOver the study period the proportion of women having a mastectomy reduced from 58% to 52%. The proportion varied from 14% to 80% according to NHS Trust. LOS decreased by 21% from 1997-98 to 2004-05 LOSratio = 0.79, 95%CI 0.77-0.80. BCS was associated with 33% shorter hospital stays compared to mastectomy LOSratio = 0.67, 95%CI 0.66-0.68. Older age, advanced disease, presence of comorbidities, lymph node excision and reconstructive surgery were associated with increased LOS. Significant variation remained amongst Trusts and surgical teams.

ConclusionThe number of days spent in hospital after breast cancer surgery has continued to decline for several decades. The change from mastectomy to BCS accounts for only 9% of the overall decrease in LOS. Other explanations include the adoption of new techniques and practices, such as sentinel lymph node biopsy and early discharge. This study has identified wide variation in practice with substantial cost implications for the NHS. Further work is required to explain this variation.

AbbreviationsBCSBreast conserving surgery

FCEFinished consultant episode

HESHospital episode statistics

LOSLength of stay

LOSRLength of stay ratio

MRECMulti-centre Research Ethics Committee

NIGBNational Information Governance Board

SLNBSentinel lymph node biopsy

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-9-202 contains supplementary material, which is available to authorized users.

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Author: Amy Downing - Mark Lansdown - Robert M West - James D Thomas - Gill Lawrence - David Forman

Source: https://link.springer.com/



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