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International Journal for Quality in Health Care 14:411-418 (2002)
© 2002 International Society for Quality in Health Care

Paper

A first look at variations in use of breast conserving surgery at five teaching hospitals in Japan

TATSURO ISHIZAKI, YUICHI IMANAKA, MASAHIRO HIROSE, KAZUAKI KUWABARA, TOSHIO OGAWA and YOSHIAKI HARADA

Department of Healthcare Economics and Quality Management, School of Public Health, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan

Objective. We assessed variations in the use of breast conserving surgery (BCS) for operable breast cancer patients among hospitals in Japan, and then compared the length of stay (LOS) and total charges during hospitalization between patients who received BCS and those who received mastectomy.

Setting and study participants. We used a database from the Voluntary Hospitals of Japan Quality Indicator Project that involved 10 teaching hospitals in Japan. We selected female operable breast cancer patients who were admitted to five of these hospitals from January 1996 to December 1999 (n = 614).

Main outcome measures. Proportion of the use of BCS, LOS, and total charges during hospitalization.

Results. Twenty-six percent of 614 subjects in the five hospitals received BCS. Proportions of the use of BCS varied from 9% to 51% across five hospitals during the 4-year period. Multiple logistic regression analysis revealed that when we selected as a reference one hospital that had the same proportion of the use of BCS (26%) as the average proportion among all hospitals, three hospitals were 0.3, 2.0, and 2.6 times more likely to use BCS than the reference (P < 0.05). LOS for BCS [mean 25.0 days, standard deviation (SD) 11.8 days] was significantly shorter than for mastectomy (mean 27.3 days, SD 8.6 days), and total charges during hospitalization for BCS (mean US$7771.5, SD 2676.7) were significantly lower than for mastectomy (mean US$8502.5, SD 2044.0). Linear mixed models confirmed that the use of BCS was significantly associated with shorter LOS (P < 0.001) and lower total charges (P < 0.001).

Conclusion. This preliminary description of breast cancer care in five teaching hospitals in Japan revealed variations in the use of BCS.

Keywords: breast cancer, breast conserving surgery, cost, Japan, length of stay, mastectomy


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