Abstract
Introduction
Modern information technology coupled with synoptic methodology allows point of care,
real time outcomes generation. Our objective was to review province-wide breast cancer
surgery outcomes from a prospective synoptic operative record to demonstrate its value
in knowledge translation.
Methods
All synoptic reports for breast cancer procedures from 2006 until March 2010 were
reviewed and descriptively analyzed. Key outcomes included frequency of breast cancer
procedures captured over time, methods of breast cancer detection, clinical staging,
method of axillary staging, breast conservation and reconstruction rates. Further
analysis involved important decision-making for mastectomy and resource allocation
for surgery.
Results
Four thousand nine hundred fifty-five breast cancer procedures were recorded synoptically;
greater than 80% of cases provincially. Method of breast cancer detection was 49%,
45% and 4% by screening radiology, patient or family, and physician, respectively.
Pathologic diagnoses were via core or mammotome biopsy in 94%; nearly half of all
patients were clinical Stage I at time of operation. Overall rate of breast conservation
was 48%. Of the 65% who had no contra-indication to breast conservation surgery, 76%
had breast conservation and 4% had primary reconstruction. Of those having mastectomy,
one third were due to patient choice. Seventy-nine percent had sentinel node staging,
18% had full axillary dissection and 3% had no axillary staging.
Conclusion
A new paradigm of creating medical records using synoptic electronic templates allows
prospective outcomes generation at point of care by the surgeon which is unparalleled
in its depth of surgical detail capturing surgical decision-making.
Keywords
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Article info
Publication history
Accepted:
June 1,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
