Defining Quality Indicators for Breast Device Surgery: Using Registries for Global Benchmarking.
Husna Begum, Swarna Vishwanath, Michelle Merenda, Mark Tacey, Nicola Dean, Elisabeth Elder, Marc Mureau, Ron Bezic, Pamela Carter, Rodney D Cooter, Anand Deva, Arul Earnest, Michael Higgs, Howard Klein, Mark Magnusson, Colin Moore, Hinne Rakhorst, Christobel Saunders, Birgit Stark, Ingrid Hopper
Author Information
Husna Begum: Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
Swarna Vishwanath: Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
Michelle Merenda: Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
Mark Tacey: Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
Nicola Dean: Department of Plastic and Reconstructive Surgery, Flinders Medical Center, Flinders University, South Australia, Australia.
Elisabeth Elder: Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
Marc Mureau: Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Ron Bezic: Refine Cosmetic Clinic, New South Wales, Australia.
Pamela Carter: Therapeutic Goods Administration, Australian Capital Territory Australia.
Rodney D Cooter: Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
Anand Deva: Macquarie Plastic & Reconstructive Surgery, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia.
Arul Earnest: Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
Michael Higgs: Parkside Cosmetic Surgery, South Australia Australia.
Howard Klein: South Island Plastic Surgery, Christchurch, New Zealand.
Mark Magnusson: School of Medicine, Griffith University, Queensland, Australia; Australasian College of Cosmetic Surgery, New South Wales, Australia.
Colin Moore: Refine Cosmetic Clinic, New South Wales, Australia.
Hinne Rakhorst: Department of Plastic, Reconstructive and Hand surgery, Medisch Spectrum Twente and ZGT Almelo, Enschede, The Netherlands.
Christobel Saunders: School of Medicine, University of Western Australia, Western Australia, Australia.
Birgit Stark: Kliniken f��r Rekonstruktiv Plastikkirurgi Karolinska Institute, Stockholm, Sweden.
Ingrid Hopper: Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
Breast device registries monitor devices encompassing breast implants, tissue expanders and dermal matrices, and the quality of care and patient outcomes for breast device surgery. Defining a standard set of quality indicators and risk adjustment factors will enable consistency and adjustment for case-mix in benchmarking quality of care across breast implant registries. This study aimed to develop a set of quality indicators to enable assessment and reporting of quality of care for breast device surgery which can be applied globally. METHODS: A scoping literature review was undertaken, and potential quality indicators were identified. Consensus on the final list of quality indicators was obtained using a modified Delphi approach. This process involved a series of online surveys, and teleconferences over 6 months. The Delphi panel included participants from various countries and representation from surgical specialty groups including breast and general surgeons, plastic and reconstructive surgeons, cosmetic surgeons, a breast-care nurse, a consumer, a devices regulator (Therapeutic Goods Administration), and a biostatistician. A total of 12 candidate indicators were proposed: Intraoperative antibiotic wash, intraoperative antiseptic wash, preoperative antibiotics, nipple shields, surgical plane, volume of implant, funnels, immediate versus delayed reconstruction, time to revision, reoperation due to complications, patient satisfaction, and volume of activity. RESULTS: Three of the 12 proposed indicators were endorsed by the panel: preoperative intravenous antibiotics, reoperation due to complication, and patient reported outcome measures. CONCLUSION: The 3 endorsed quality indicator measures will enable breast device registries to standardize benchmarking of care internationally for patients undergoing breast device surgery.
