About the Metric
Definition
The percentage of patients who underwent a re-excision within 3 months after the initial breast conserving therapy (BCT), i.e. partial mastectomy or “lumpectomy.”
Background
Although a breast re-excision after breast conserving surgical therapy (BCT), 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.
Cornerstone (index) event of the measure
Initial BCT operation
How It Works
Numerator
The number of patients from the denominator who underwent a re-excision (CPT codes: 19120, 19125, 19126, 19301, 19302) performed by the same physician within 3 months after the initial breast-conserving therapy.
Denominator
The number of patients who underwent an initial breast-conserving therapy (BCT) (CPT codes: 19120, 19125, 19126, 19301, 19302) performed by a given physician.
Inclusion Criteria
- Patients 18 years of age or older
- A diagnosis of breast cancer (ICD-10-CM codes: C50.011 – C50.929, D05.00-D05.92) anytime within 3 months before or after their initial breast conserving therapy (BCT)
- Three months of continuous data before the index BCT and 3 months of continuous data after BCT
Exclusion Criteria
- Patients with any history of prior modified radical or radical mastectomy (CPT codes:, 19303, 19305, 19306, 19307) before the day of the patient’s initial breast conserving therapy (BCT) (CPT codes: 19120, 19125, 19126, 19301, 19302)
Patients whose initial breast conserving therapy (CPT codes: 19120, 19125, 19126, 19301, 19302) was performed by multiple surgeons
- Patients who received a re-excision procedure by a surgeon different from the one who performed the initial breast conserving therapy (BCT)
Patients with less than 3 months’ medical history available prior to their initial breast conserving therapy (BCT)
- Patients of male sex
Attribution
The physician performing the re-excision procedure.
GAM Thresholds™
GAM establishes clinical thresholds using the input of key physician leaders within a specialty and the GAM clinical team. GAM utilizes an elaborate consensus building process with final adjudication by our leadership team.
| Cases | Pattern of Concern | Outlier |
|---|---|---|
|
6-9 |
35-50% |
>50% |
|
10+ |
25-30% |
>30% |
Supporting Literature
