INAPPROPRIATE HALSTED MASTECTOMY AND PATIENT VOLUME IN ITALIAN HOSPITALS

To study whether Halsted mastectomy was used only when properly indica ted, a prospective survey was undertaken on the process of care of 985 breast cancer patients seen consecutively at 62 general hospitals in Northern and Central Italy. Overall, 79% of Halsted mastectomies were performed inappropriately. The procedure was less likely to be perform ed on more educated patients and, other factors considered, on those s een at hospitals with larger volume. We conclude that the measurement of utilization of a surgical procedure for which only a few appropriat e indications exist may help identify important relationships between hospital characteristics and quality of surgical care.