1. The National Mastectomy and Breast Reconstruction Audit Key findings of the Third Annual Report Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

2. Audit aims To describe provision of mastectomy and breast reconstruction services in England To investigate determinants and outcomes of care for women with breast cancer having a mastectomy with or without breast reconstruction Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

3. Audit methodology The Audit prospectively enrolled –women with breast cancer –who underwent mastectomy or breast reconstruction surgery –in the NHS and independent sector in England –between 1 January 2008 and 31 March 2009 Data collected by –clinicians on clinical practice and inpatient outcomes –patients on treatment options, patient-reported outcomes and experience of care Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

4. Audit participation – clinical study 18,216 women with complete information: –16,558 treated at English NHS trusts –1,249 treated at independent hospitals –409 treated at non-English NHS trusts that also chose to participate Overall NHS case ascertainment of 81.4% More than two thirds of NHS trusts had over 75% case ascertainment Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

5. Audit participation – PROMs study 10,521 women asked to participate in patient- reported outcome measures (PROMs) study –8,636 (82%) gave their consent 8,159 women sent questionnaires –6,882 (84%) returned a completed questionnaire Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

6. Third Annual Report Provides information on: Patient characteristics, treatment and inpatient outcomes Patient-reported experience of care and post-discharge complications, collected 3-months after surgery Results presented by type of surgery –mastectomy only, mastectomy with immediate reconstruction, and delayed reconstruction Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

7. Providing reconstructive information and choice Among women having immediate or delayed reconstruction, –90% felt that they got the right amount of information about their surgery Among women having mastectomy-only –91% felt that they got the right amount of information about their surgery –65% felt that they got the right amount of information about breast reconstruction 8% of mastectomy-only women stated that a lack of local availability was one of the reasons why they did not have immediate reconstruction Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

8. Recommendation 1 Clinicians should act to better inform women about both the procedures they decide to undergo and the reconstructive options available. As per the 2009 NICE guidance, clinicians should ensure that women are offered a full range of appropriate reconstructive options, whether or not these are available locally. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

9. Providing appropriate pain relief In 1997, the Audit Commission recommended that less than 5% of patients should report experiencing severe postoperative pain 6.2% of mastectomy-only patients experienced severe pain in the first 24 hours 16.5% of immediate and 20.1% of delayed reconstruction patients experienced severe pain in the first 24 hours Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

10. Recommendation 2 NHS trusts and independent hospitals should ensure that women understand how to report their levels of pain and access appropriate pain relief, and that they are provided with adequate psychological support following their surgery. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

11. High levels of patient satisfaction Women undergoing mastectomy and breast reconstruction rated the care they received very highly Overall quality of care was rated as excellent by –66% of mastectomy-only patients –72% of immediate & 74% of delayed reconstruction patients In comparison, 43% of patients in 2008 NHS inpatient survey rated their quality of care as excellent Over 85% of women said they were always treated with respect and dignity Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

12. Recommendation 3 NHS trusts and independent hospitals should continue to monitor patients’ experience with care and act to maintain the high levels of satisfaction reported. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

13. Using data to inform patients Serious inpatient complications after surgery are rare However: –One in ten women had an inpatient complication –One in ten mastectomy-only patients and one in six reconstruction patients was readmitted for unplanned treatment or surgery after their primary admission –One in five mastectomy-only patients and one in four reconstruction patients required antibiotic treatment for a suspected wound infection post-discharge Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

14. Recommendation 4 Clinicians should use the data on inpatient and postoperative complications to inform women about risks of different operations. Women considering reconstruction should be informed pre-operatively that the chance of requiring further surgery either during their initial admission or postoperatively is around one in ten. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

15. Benchmarking using the national results Organisational complication rates were published for: –Returned to theatre, –Mastectomy site complications –Distant or systemic complication Risk-adjusted complication rates for the organisations were within the range expected Some organisations were excluded due to low case- ascertainment or incomplete outcomes data Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

16. Recommendation 5 Multidisciplinary teams at NHS trusts and independent hospitals should review the outcomes of their own patients and compare them with the national outcomes described in this report to ensure that they are delivering a high quality of care. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

17. Informing future guidelines The Audit represents the first national prospective study of women undergoing mastectomy and breast reconstruction surgery The clinician and patient-reported data collected during the Audit has expanded the evidence base, and its findings should be used to refine both local and national guidelines Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

18. Recommendation 6 The Surgical Associations and Royal Colleges involved in mastectomy and breast reconstruction surgery should consider issuing new guidance on patient selection, operative techniques and postoperative care. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

19. Fourth Annual Report This will include: –Data on women’s quality of life 18 months after surgery –National comparative analyses of key patient-reported outcome measures –Validation of clinician-reported national and local inpatient complication rates by linking audit data to Hospital Episode Statistics records The report will be published in March 2011 Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

20. Thank you! Please e-mail mbr@ic.nhs.uk or rjeevan@rcseng.ac.uk or call 0113 254 7139 for copies of any of the Audit reports or if you have any queriesmbr@ic.nhs.ukrjeevan@rcseng.ac.uk Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010