Association of Surgeon Volume with Adherence to American Society of Breast Surgeons Surgical Quality Measures

BACKGROUND: Surgical volumes have long been correlated with outcomes, but their relationship to quality measures (QMs) remains unclear. This study aimed to examine the association between surgeon volumes and American Society of Breast Surgeons QM performance.

METHODS: The study analyzed 635,252 women in the National Cancer Database 18 years old or older with stage I, II, or III breast cancer who underwent surgery between 1 January 2018 and 31 December 2022. Surgeon volume was calculated as tertiles using National Provider Identifiers. Quality measures included treatment timeliness, axillary management, and multidisciplinary care. Adjusted multilevel logistic models, with hospital as a random effect, were used to investigate associations of volume with QM performance.

RESULTS: Low-volume (LV), average-volume (AV), and high-volume (HV) surgeons annually performed a median of 33 (interquartile range [IQR], 17-48), 98 (IQR, 80-112), and 169 (IQR, 147-202) breast cancer surgeries, respectively. Low-volume surgeons cared for a higher proportion of older, non-white, and non-metropolitan patients and were more likely to provide timely surgery (odds ratio [OR], 1.12; 95 % confidence interval [CI], 1.09-1.14), but less likely to adhere to adjuvant radiotherapy (odds ratio [OR], 0.81; 95 % confidence interval [CI], 0.77-0.85), appropriate axillary management (OR, 0.65; 95 % CI, 0.57-0.74), and sentinel lymph node biopsy (SLNB) omission (OR, 0.69; 95 % CI, 0.65-0.73). For LV surgeons, breast center accreditation was associated with increased radiotherapy referral (OR, 1.28; 95 % CI, 1.14-1.44) and SLNB omission (OR, 1.47; 95 % CI, 1.23-1.76).

CONCLUSION: Low-volume surgeons had greater variability in breast QM performance and may benefit from efforts, including education and strengthening multidisciplinary communication, to improve breast cancer care for vulnerable populations.