Quality indicators for breast reconstruction following cancer - an international Delphi consensus study supported by the European Society of Plastic, Reconstructive and Aesthetic Surgery

Hansson E, Moellhoff N, Ahlstedt Karlsson S, Uusimäki A, Kaartinen I, Rosenkrantz Hölmich L, Zic R, Waters R, Henley M, Giunta RE, Elander A, Orellana TA, Anacleto JC, Arkudas A, Di Benedetto G, Benoit C, Madsen LB, Ozden BC, Skogh ACD, Damsgaard TE, Marcos PG, Gilis A, Gilmour A, Guerrero Paez C, Hamdi M, Harder Y, Jecan CR, Karhunen-Enckell U, Korvald C, Leyva F, Maliszewski D, Mani M, Merkkola-Von Schantz P, Kristoffersen CM, Nelissen X, Pandis L, Papadopulos NA, Pieper S, Rakhorst H, Ressa M, Salgarello M, Di Pompeo FS, Sharma K, Sjøberg T, Sundbøll K, de la Cal CT, Tušek ME, Yus CV, Wolfram D (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Book Volume: 9

Article Number: zraf144

Journal Issue: 6

DOI: 10.1093/bjsopen/zraf144

Abstract

Background Quality indicators (QIs) are essential for assessing and improving healthcare delivery. Existing QIs for breast reconstruction are limited and do not comprehensively reflect clinical complexity or patient-centred outcomes. This study aimed to develop a scientifically grounded, consensus-based set of QIs for breast reconstruction using the Delphi method. Methods A structured Delphi process was conducted. Experts, including plastic surgeons, reconstructive nurses, and patient representatives from 21 European countries, were nominated by national professional and patient organizations. A pre-round generated 141 unique QIs, thematically analysed and categorized into six domains. Three Delphi rounds were conducted via electronic surveys. Consensus was defined a priori as ≥ 75% agreement across the whole group or at least two subgroups. Indicators were classified according to Donabedian's model (structure, process, outcome). Results Among the 43 experts completing all rounds, 41 QIs reached final consensus. These indicators span six key quality domains (Safety, Timeliness, Effectiveness, Efficiency, Equity, and Patient-centredness) and include measures such as access to reconstruction, treatment timelines, multidisciplinary collaboration, unit characteristics, surgical outcomes, and patient satisfaction. Structure, process, and outcome indicators were all represented, including patient-reported outcomes and patient-reported experiences. Conclusion This Delphi study provides the first comprehensive set of QIs specific to breast reconstruction in Europe. These indicators lay the groundwork for future standardization, benchmarking, and quality improvement initiatives. Further work is needed to operationalize the indicators through evidence grading, measurement specifications, risk adjustment, and integration into clinical practice.

Authors with CRIS profile

Involved external institutions

Istituto Tumori Bari Giovanni Paolo II Italy (IT) Queen Elizabeth Hospital Birmingham United Kingdom (GB) NHS Greater Glasgow and Clyde United Kingdom (GB) Sahlgrenska University Hospital / Sahlgrenska Universitetssjukhuset Sweden (SE) Hospital General Universitario Gregorio Marañón Spain (ES) Klinikum der Universität München (LMU Klinikum) Germany (DE) Uppsala University Hospital / Akademiska sjukhuset Sweden (SE) Fondazione Policlinico Universitario Agostino Gemelli IRCCS Italy (IT) Centre Hospitalier Universitaire de Liège (CHU Liège) Belgium (BE) Karolinska University Hospital / Karolinska Universitetssjukhuset Sweden (SE) Champalimaud Foundation / Fundação Champalimaud Portugal (PT) University Medical Center Groningen (UMCG) / Universitair Medisch Centrum Groningen Netherlands (NL) Copenhagen University Hospital Denmark (DK) Haukeland University Hospital / Haukeland universitetssykehus Norway (NO) Pauls Stradiņš Clinical University Hospital / Paula Stradiņa Klīniskā universitātes slimnīca Latvia (LV) Dutch Breast Cancer Association / Borstkankervereniging Nederland - BVN Netherlands (NL) Brussels University Hospital (H.U.B) / Hôpital Universitaire de Bruxelles Belgium (BE) Hospital Universitario La Paz Spain (ES) University Hospital of North Norway / Universitetssykehuset Nord-Norge (UNN) Norway (NO) Università Politecnica delle Marche (UNIVPM) / Marche Polytechnic University Italy (IT) Danish Breast Cancer Cooperative Group (DBCG) Denmark (DK) Swedish Breast Cancer Association / Bröstcancerförbundet Sweden (SE) American Hospital / VKV Amerikan Hastanesi Turkey (TR) Odense Universitetshospital (OUH) Denmark (DK) Janusz Korczak Provincial Specialist Hospital Poland (PL) Università degli studi "La Sapienza" Italy (IT) Spanish Breast Cancer Group / Grupo Español de Investigación en Cáncer de Mama (GEICAM) Spain (ES) Medizinische Universität Innsbruck Austria (AT) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) Switzerland (CH) Oslo University Hospital / Oslo Universitetssykehus Rikshospitalet Norway (NO) Cancer Patients Europe Belgium (BE) University of Padua / Universita degli Studi di Padova Italy (IT) Tampere University Hospital / Tampereen yliopistollinen sairaala (TAYS) Finland (FI) Institut Curie France (FR) Carol Davila University of Medicine and Pharmacy / Universitatea de Medicină și Farmacie „Carol Davila” (UMF București) Romania (RO) University Hospital Dubrava Croatia (HR) Nottingham University Hospitals United Kingdom (GB) Helsinki University Central Hospital (HUCH) / Helsingin seudun yliopistollinen keskussairaala (HYKS) Finland (FI)

How to cite

APA:

Hansson, E., Moellhoff, N., Ahlstedt Karlsson, S., Uusimäki, A., Kaartinen, I., Rosenkrantz Hölmich, L.,... Wolfram, D. (2025). Quality indicators for breast reconstruction following cancer - an international Delphi consensus study supported by the European Society of Plastic, Reconstructive and Aesthetic Surgery. BJS Open, 9(6). https://doi.org/10.1093/bjsopen/zraf144

MLA:

Hansson, Emma, et al. "Quality indicators for breast reconstruction following cancer - an international Delphi consensus study supported by the European Society of Plastic, Reconstructive and Aesthetic Surgery." BJS Open 9.6 (2025).

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