The Costs and Complications Associated with Repeated Breast-Conserving Surgeries

Women undergoing a repeat surgery were 88 percent more likely to experience multiple complications.

Women who undergo partial mastectomies (also known as breast-conserving surgery or lumpectomy) sometimes have a second operation to remove remaining tissue that a pathology report suggests still contains a few tumor cells. Research, though, indicates that the repeat surgeries depend less on the patient than they do on the surgeon reading the reports.

Time magazine, quoting a study published in the Journal of the American Medical Association, reported that rates of repeat surgery varied between 0 percent and 70 percent depending on the surgeon, and from 1.7 percent to 21 percent depending on the hospital.

“The study found that nearly half of the repeat surgeries were done in women whose pathology reports showed no evidence of residual tumor cells,” the magazine reported.

What Our Claims Analysis Reveals

Last year, the company that operates Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas teamed up with industry experts Diagnostic Photonics Inc. of Chicago and the University of Texas MD Anderson Cancer Center in Houston to take a closer look at the often unnecessary and expensive follow-up lumpectomies women undergo. The study, presented at the American Society of Clinical Oncology in June, found evidence that women who undergo additional breast surgery often suffer medical complications associated with the follow-up surgery.

The study analyzed private claims data for close to 10,000 Blue Cross and Blue Shield members who had lumpectomies between January 2010 and December 2013. The study found:

  • 77 percent of the women had one lumpectomy operation.
  • 23 percent of the women had at least one repeat surgery, and complications were 48 percent more common in those cases.
  • Women undergoing a repeat surgery were 88 percent more likely to experience multiple complications, including infection, hematoma/seroma and breast pain.
  • The average additional cost was $16,072 for those who underwent follow-up surgeries.

Next Steps to Help Improve Outcomes

The Blue Cross and Blue Shield Plans next will explore ways to improve surgical outcomes for members – and reduce costs – by exploring a low-cost technology solution that will reduce the excess breast tissue removed, and avoid complications and repeat surgeries. A deeper look into the variation in care may help reveal what drives repeat surgeries, and how and where access to new technology can be most beneficial.

UPDATE: The findings described in this article were subsequently published Aug. 2, 2017, by the medical journal JAMA Surgery.

 

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