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 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

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) 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

  1. Patients 18 years of age or older
  2. 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)
  3. Three months of continuous data before the index BCT and 3 months of continuous data after BCT

Exclusion Criteria

  1. 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)
  2. Patients whose initial breast conserving therapy (CPT codes: 19120, 19125, 19126, 19301, 19302) was performed by multiple surgeons

  3. Patients who received a re-excision procedure by a surgeon different from the one who performed the initial breast conserving therapy (BCT)
  4. Patients with less than 3 months’ medical history available prior to their initial breast conserving therapy (BCT)

  5. 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.

  • Sample Size: 6-9

    This threshold applies to a clinician with a 6-9 cases.

  • Pattern of Concern: 35-50%

    This constitutes the clinical threshold for a "pattern of concern."

  • Outlier: >50%

    This constitutes the clinical threshold for an "outlier."

  • Sample Size: 10+

    This threshold applies to a clinician with a minimum of 10 cases.

  • Pattern of Concern: 25-30%

    This constitutes the clinical threshold for a "pattern of concern."

  • Outlier: >30%

    This constitutes the clinical threshold for an "outlier."

Cases Pattern of Concern Outlier
6-9
35-50%
>50%
10+
25-30%
>30%