Repeated Breast Surgery After a Lumpectomy in England
Author(s)
Joana Pestana, PhD1, Sam Wing, MPH, PhD2, Josephine Ngugi, MBBS, MHB, MSc and MS3, Jajini Varghese, MRCS, MPhil, PhD(Cantab), FRCS(Plast)3.
1Intuitive Surgical, Freiburg, Germany, 2Intuitive Surgical, Sunnyvale, CA, USA, 3Royal Free Hospital and Division of Surgery and Interventional Science, UCL, London, United Kingdom.
1Intuitive Surgical, Freiburg, Germany, 2Intuitive Surgical, Sunnyvale, CA, USA, 3Royal Free Hospital and Division of Surgery and Interventional Science, UCL, London, United Kingdom.
OBJECTIVES: This study aimed to evaluate treatment patterns and the burden of repeated breast surgery following breast-conserving surgery (BCS) in England. We assessed the reoperation rate, high-risk patient profiles, and post-index healthcare resource utilization (HCRU).
METHODS: A retrospective cohort analysis was conducted using Hospital Episode Statistics data. The cohort included women diagnosed with breast cancer between 2013 and 2024 who underwent BCS. Patient sociodemographics, comorbidities, BMI, smoking history, treatments, and healthcare costs within one year postoperatively were analyzed.
RESULTS: Among the study cohort, 214,636 women (36%) underwent BCS as their initial surgery, and 21,929 (10%) had secondary procedures; 42% (n=9,174) had a second lumpectomy and 58% (n=12,755) underwent a mastectomy. Woman who underwent a secondary procedure were younger (mean age 58.55 vs. 61.86 years) and those with a Charlson Comorbidity Index >2 were less likely to experience a secondary procedure (1.88% vs. 2.48%). Differences by sociodemographics were modest, though Black women were slightly more likely to undergo reoperation (2.26% vs. 1.62%). Reoperations were more frequent when the initial surgery was performed by general surgeon (15.35% vs. 14.09%) and after longer NHS wait times (0.95 vs. 0.81 months). HCRU and costs increased substantially with repeat surgeries. Inpatient visits per patient-year rose from 1.52 (cost: £2,063) for primary BCS only to 1.73 (cost: £2,461) for patient with a further BCS and 2.45 (cost: £3,588) for those undergoing secondary mastectomies. Outpatient visits increased from 8.55 (£718) to 9.76 (£847) and 12.30 (£1,124), respectively.
CONCLUSIONS: Despite being the most common surgical approach for early-stage breast cancer, BCS may not be definitive resection in a subset of high-risk patients. The findings underscore the need for enhanced preoperative planning and counseling to minimize the likelihood of repeat surgery. Healthcare providers can tailor initial treatment strategies more effectively, potentially reducing the burden on patients and the NHS.
METHODS: A retrospective cohort analysis was conducted using Hospital Episode Statistics data. The cohort included women diagnosed with breast cancer between 2013 and 2024 who underwent BCS. Patient sociodemographics, comorbidities, BMI, smoking history, treatments, and healthcare costs within one year postoperatively were analyzed.
RESULTS: Among the study cohort, 214,636 women (36%) underwent BCS as their initial surgery, and 21,929 (10%) had secondary procedures; 42% (n=9,174) had a second lumpectomy and 58% (n=12,755) underwent a mastectomy. Woman who underwent a secondary procedure were younger (mean age 58.55 vs. 61.86 years) and those with a Charlson Comorbidity Index >2 were less likely to experience a secondary procedure (1.88% vs. 2.48%). Differences by sociodemographics were modest, though Black women were slightly more likely to undergo reoperation (2.26% vs. 1.62%). Reoperations were more frequent when the initial surgery was performed by general surgeon (15.35% vs. 14.09%) and after longer NHS wait times (0.95 vs. 0.81 months). HCRU and costs increased substantially with repeat surgeries. Inpatient visits per patient-year rose from 1.52 (cost: £2,063) for primary BCS only to 1.73 (cost: £2,461) for patient with a further BCS and 2.45 (cost: £3,588) for those undergoing secondary mastectomies. Outpatient visits increased from 8.55 (£718) to 9.76 (£847) and 12.30 (£1,124), respectively.
CONCLUSIONS: Despite being the most common surgical approach for early-stage breast cancer, BCS may not be definitive resection in a subset of high-risk patients. The findings underscore the need for enhanced preoperative planning and counseling to minimize the likelihood of repeat surgery. Healthcare providers can tailor initial treatment strategies more effectively, potentially reducing the burden on patients and the NHS.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE648
Topic
Economic Evaluation, Medical Technologies, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Reproductive & Sexual Health, Surgery