Jämtland Västra Götaland Halland Sörmland Västmanland Värmland Stockholm Uppsala Norrbotten Västerbotten Blekinge SWEDEN Jönköping Östergötland Dalarna Skåne Kalmar Västernorrland Gävleborg Örebro Gotland Kronoberg
4.5 6.8 6.9 7.3 8.4 8.4 8.6 8.7 8.8 9.1 9.6 9.6 10.1 11.0 11.0 11.6 12.8 13.4 13.7 16.0 17.5 17.6
32.8
0
5
10
15
2010
Figure 123 Women
20
25 Percent
Percentage of women with breast cancer who were reoperated on due to tumour data, 2010. Source: National Breast Cancer Register
The Swedish National Board of Health and Welfare is currently updating its breast cancer guidelines and will publish them, along with an evaluation, in March 2013. One of the indicators that will be monitored is the percentage of reoperations due to tumour data. This indicator measures both the quality of preoperative malignancy assessment and how successful the surgeon is in removing the tumour. Figure 23 shows the number of patients who were reoperated on due to tumour data in 2011. Of the 7 370 patients covered by the comparison, 710 or 9.6 per cent (down from 11.9 per cent in 2009) had a reoperation. The counties ranged from 4.5 to 17.6 per cent. The data are based on relatively few cases, thereby generating a wide confidence interval. Errors may also have occurred because not all hospitals reported reoperations to the National Breast Cancer Register. Outcomes should also be related to the degree to which breast-preserving surgery, which increases the risk of reoperation, had been performed – and whether or not the purpose of primary surgery was to confirm a cancer diagnosis. In the view of the Swedish Association for Breast Cancer Surgery, an intervention needs to be as definitive as possible in order to avoid reoperation, which should be performed on the basis of tumour data in fewer than 10 per cent of all cases. Approximately half of the counties met that target in this year’s comparison. QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2012
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