Metric 07

Metric Category: Appropriateness

Re-excision After Initial Breast Conserving Surgery

About the Metric

Definition

The percentage of patients who underwent a re-excision within 12 months after the initial breast-conserving therapy (i.e. partial mastectomy or “lumpectomy”). 

Background

Although a breast re-excision after breast conserving surgical therapy (i.e. partial mastectomy or “lumpectomy”).is an established practice in the setting of positive margins, over-use of re-excision is associated with increased healthcare costs and a greater risk of a postoperative complication, an inferior cosmetic result, added emotional distress, and an unnecessary delay to adjuvant chemotherapy. It is important to minimize re-excision risk when it does not compromise patient safety or adequacy of tumor margin status. .

Metric Ratings

Evidence
4/5
Expert Consensus
5/5
Clinician Buy-in
3.5/5
Economic Impact
4/5
Reduction in Avoidable Harm
4/5
Applicability to Medicare Data
4.5/5
Applicability to Medicaid
5/5

Applicable to EHR Data?

Requires Pharmacy Data?

How It Works

Numerator

The number of patients from the denominator who underwent a re-excision (CPT codes: 19120, 19125, 19126, 19301, 19302, 19303, 19304, 19305, 19306, 19307) performed by the same physician within 12 months after the initial breast-conserving therapy. 

Denominator

The number of patients who underwent an initial breast-conserving therapy (CPT codes: 19120, 19125, 19126, 19301, 19302) performed by a given physician. 

Inclusion Criteria

All patients aged 18 years or older who underwent an initial breast conserving therapy during the study period. 

Exclusion Criteria

  1. Patients without a diagnosis of breast cancer (ICD-10-CM codes: C50, D05.1) within 6 months before or after their initial breast conserving therapy (CPT codes: 19125, 19126, 19301, 19302, 19160, 19120)
  2. Patients with any history of breast operation (CPT codes: 19125, 19126, 19301, 19302, 19160, 19120, 19303, 19304, 19305, 19306, 19307, 19100, 19101, 19102, 19103, 19081, 19082,19083, 19084,19085, 19086,19318, 19324, 19325, 19340, 19342, 19316) before their initial breast conserving therapy (CPT codes: 19125, 19126, 19301, 19302, 19160, 19120)
  3. Patients whose initial breast conserving therapy (CPT codes: 19125, 19126, 19301, 190302, 19160, 19120) was performed by multiple surgeons
  4. Patients who received a re-excision procedure by a surgeon different from the one who performed the initial breast conserving therapy (CPT codes: 19125, 19126, 19301, 19302, 19160, 19120)
  5. Patients with less than 6 months’ medical history available prior to their initial breast conserving therapy (CPT codes: 19125, 19126, 19301, 19302, 19120)
  6. Patients of male sex

Attribution

None.

GAM™ Thresholds

Minimal number of patients required in the denominator Clinical threshold of what constitutes an outlier
>10 ≥9%