Mastectomy Outcomes for Patients Treated at VA Hospitals: Results from a National Study

Hynes DM, Weaver FM, Ippolito D. Mastectomy Outcomes for Patients Treated at VA Hospitals: Results from a National Study. Paper presented at: American Public Health Association Annual Meeting and Exposition; 1999 Nov 1; Chicago, IL.

Research Objective: To explore and examine relationships between patient sociodemographic, preoperative risk, structure and process characteristics and clinical outcomes of mastectomy patients at VAMCs.Study Design: Using information collected from the Department of Veterans Affairs (VA) National Surgical Quality Improvement Program (NSQIP), we identified all mastectomies performed at VA facilities between October, 1992 and September, 1997. Data included the NSQIP database with information on 62 preoperative risk and demographic characteristics, four process, and 23 outcome variables, supplemented with readmission data from the VA's Patient Treatment File, pathology reports, and facility characteristic data. Outcomes included: postoperative length of stay, morbidity within 30 days (i.e., one or more of 21 complications monitored by the NSQIP), and any readmissions that occurred as a result of a complication of the procedure within one year post surgery. Logistic regression modeling was used to examine the impact of multiple factors on mastectomy outcomes. Principal Findings: Over a six year period, 1,333 mastectomies (60% female; 40% male) were performed. The leading indication for surgery was malignant neoplasm of breast (43%). Mastectomy procedures included 4% radical, 28% modified radical and 68% partial mastectomy/lumpectomy or other. Within 30 days of the procedure, 8% experienced one or more of the 21 complications. Logistic regression modeling of 30-day morbidity identified 5 significant predictors including presence of diabetes, cognitive impairment, presence of wound infection; diagnosis of cancer, and longer operation time (c-index = 0. 72). Hospital structural characteristics, including whether the VA hospital was a designated Women Veteran Comprehensive Health Care Center, were not significant predictors in the model. Regression modeling of length of stay, and readmissions also will be presented. Conclusions: This study will provide important information about the relationship between patient, process, and structural characteristics with mastectomy outcomes when surgical volume is low.