Mastitis and Mammary Abscess Management Audit (MAMMA) in the UK and Ireland

MAMMA Research Collaborative; Alona Courtney; Jonathon Clymo; Ruth Parks; Alexander Wilkins; Ruth Brown; Rachel O'Connell; Rajiv Dave; Marianne Dillon; Hiba Fatayer; Rachel Gallimore; Ashu Gandhi; Matthew Gardiner; Victoria Harmer; Lyndsey Hookway; Gareth Irwin; Charlotte Ives; Helen Mathers; Juliette Murray; D Peter O'Leary; Neill Patani; Sophie Paterson; Shelley Potter; Ruth Prichard; Giovanni Satta; T G Teoh; Paul Ziprin; Stuart McIntosh; Michael R Boland; Daniel Richard Leff

doi:10.1093/bjs/znad333

Mastitis and Mammary Abscess Management Audit (MAMMA) in the UK and Ireland

MAMMA Research Collaborative, Alona Courtney^*, Jonathon Clymo, Ruth Parks, Alexander Wilkins, Ruth Brown, Rachel O'Connell, Rajiv Dave, Marianne Dillon, Hiba Fatayer, Rachel Gallimore, Ashu Gandhi, Matthew Gardiner, Victoria Harmer, Lyndsey Hookway, Gareth Irwin, Charlotte Ives, Helen Mathers, Juliette Murray, D Peter O'LearyNeill Patani, Sophie Paterson, Shelley Potter, Ruth Prichard, Giovanni Satta, T G Teoh, Paul Ziprin, Stuart McIntosh, Michael R Boland, Daniel Richard Leff

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

Abstract

BACKGROUND: The aim of this multicentre prospective audit was to describe the current practice in the management of mastitis and breast abscesses in the UK and Ireland, with a specific focus on rates of surgical intervention.

METHODS: This audit was conducted in two phases from August 2020 to August 2021; a phase 1 practice survey and a phase 2 prospective audit. Primary outcome measurements for phase 2 included patient management pathway characteristics and treatment type (medical/radiological/surgical).

RESULTS: A total of 69 hospitals participated in phase 2 (1312 patients). The key findings were a high overall rate of incision and drainage (21.0 per cent) and a lower than anticipated proportion of ultrasound-guided aspiration of breast abscesses (61.0 per cent). Significant variations were observed regarding the rate of incision and drainage (range 0-100 per cent; P < 0.001) and the rate of needle aspiration (range 12.5-100 per cent; P < 0.001) between individual units. Overall, 22.5 per cent of patients were admitted for inpatient treatment, out of whom which 72.9 per cent were commenced on intravenous antibiotics. The odds of undergoing incision and drainage for a breast abscess or being admitted for inpatient treatment were significantly higher if patients presented at the weekend compared with a weekday (P ≤ 0.023). Breast specialists reviewed 40.9 per cent of all patients directly, despite the majority of patients (74.2 per cent) presenting within working hours on weekdays.

CONCLUSIONS: Variation in practice exists in the management of mastitis and breast abscesses, with high rates of incision and drainage in certain regions of the UK. There is an urgent need for a national best-practice toolbox to minimize practice variation and standardize patient care.

Original language	English
Article number	znad333
Number of pages	9
Journal	British Journal of Surgery
Volume	111
Issue number	1
Early online date	31 Oct 2023
DOIs	https://doi.org/10.1093/bjs/znad333
Publication status	Published - 3 Jan 2024

Bibliographical note

Keywords

Female
Humans
Abscess/surgery
Breast Diseases/surgery
Ireland/epidemiology
Mastitis/therapy
Drainage
United Kingdom/epidemiology

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MAMMA Research Collaborative, Courtney, A., Clymo, J., Parks, R., Wilkins, A., Brown, R., O'Connell, R., Dave, R., Dillon, M., Fatayer, H., Gallimore, R., Gandhi, A., Gardiner, M., Harmer, V., Hookway, L., Irwin, G., Ives, C., Mathers, H., Murray, J., ... Leff, D. R. (2024). Mastitis and Mammary Abscess Management Audit (MAMMA) in the UK and Ireland. British Journal of Surgery, 111(1), Article znad333. https://doi.org/10.1093/bjs/znad333

@article{600a371754ba4346bf3635ef0b6a0e34,

title = "Mastitis and Mammary Abscess Management Audit (MAMMA) in the UK and Ireland",

abstract = "BACKGROUND: The aim of this multicentre prospective audit was to describe the current practice in the management of mastitis and breast abscesses in the UK and Ireland, with a specific focus on rates of surgical intervention.METHODS: This audit was conducted in two phases from August 2020 to August 2021; a phase 1 practice survey and a phase 2 prospective audit. Primary outcome measurements for phase 2 included patient management pathway characteristics and treatment type (medical/radiological/surgical).RESULTS: A total of 69 hospitals participated in phase 2 (1312 patients). The key findings were a high overall rate of incision and drainage (21.0 per cent) and a lower than anticipated proportion of ultrasound-guided aspiration of breast abscesses (61.0 per cent). Significant variations were observed regarding the rate of incision and drainage (range 0-100 per cent; P < 0.001) and the rate of needle aspiration (range 12.5-100 per cent; P < 0.001) between individual units. Overall, 22.5 per cent of patients were admitted for inpatient treatment, out of whom which 72.9 per cent were commenced on intravenous antibiotics. The odds of undergoing incision and drainage for a breast abscess or being admitted for inpatient treatment were significantly higher if patients presented at the weekend compared with a weekday (P ≤ 0.023). Breast specialists reviewed 40.9 per cent of all patients directly, despite the majority of patients (74.2 per cent) presenting within working hours on weekdays.CONCLUSIONS: Variation in practice exists in the management of mastitis and breast abscesses, with high rates of incision and drainage in certain regions of the UK. There is an urgent need for a national best-practice toolbox to minimize practice variation and standardize patient care.",

keywords = "Female, Humans, Abscess/surgery, Breast Diseases/surgery, Ireland/epidemiology, Mastitis/therapy, Drainage, United Kingdom/epidemiology",

author = "{MAMMA Research Collaborative} and Alona Courtney and Jonathon Clymo and Ruth Parks and Alexander Wilkins and Ruth Brown and Rachel O'Connell and Rajiv Dave and Marianne Dillon and Hiba Fatayer and Rachel Gallimore and Ashu Gandhi and Matthew Gardiner and Victoria Harmer and Lyndsey Hookway and Gareth Irwin and Charlotte Ives and Helen Mathers and Juliette Murray and O'Leary, {D Peter} and Neill Patani and Sophie Paterson and Shelley Potter and Ruth Prichard and Giovanni Satta and Teoh, {T G} and Paul Ziprin and Stuart McIntosh and Boland, {Michael R} and Leff, {Daniel Richard} and Fairhurst, {Katherine J}",

note = "{\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.",

year = "2024",

month = jan,

day = "3",

doi = "10.1093/bjs/znad333",

language = "English",

volume = "111",

journal = "British Journal of Surgery",

issn = "0007-1323",

publisher = "Wiley",

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MAMMA Research Collaborative, Courtney, A, Clymo, J, Parks, R, Wilkins, A, Brown, R, O'Connell, R, Dave, R, Dillon, M, Fatayer, H, Gallimore, R, Gandhi, A, Gardiner, M, Harmer, V, Hookway, L, Irwin, G, Ives, C, Mathers, H, Murray, J, O'Leary, DP, Patani, N, Paterson, S, Potter, S, Prichard, R, Satta, G, Teoh, TG, Ziprin, P, McIntosh, S, Boland, MR & Leff, DR 2024, 'Mastitis and Mammary Abscess Management Audit (MAMMA) in the UK and Ireland', British Journal of Surgery, vol. 111, no. 1, znad333. https://doi.org/10.1093/bjs/znad333

TY - JOUR

T1 - Mastitis and Mammary Abscess Management Audit (MAMMA) in the UK and Ireland

AU - MAMMA Research Collaborative

AU - Courtney, Alona

AU - Clymo, Jonathon

AU - Parks, Ruth

AU - Wilkins, Alexander

AU - Brown, Ruth

AU - O'Connell, Rachel

AU - Dave, Rajiv

AU - Dillon, Marianne

AU - Fatayer, Hiba

AU - Gallimore, Rachel

AU - Gandhi, Ashu

AU - Gardiner, Matthew

AU - Harmer, Victoria

AU - Hookway, Lyndsey

AU - Irwin, Gareth

AU - Ives, Charlotte

AU - Mathers, Helen

AU - Murray, Juliette

AU - O'Leary, D Peter

AU - Patani, Neill

AU - Paterson, Sophie

AU - Potter, Shelley

AU - Prichard, Ruth

AU - Satta, Giovanni

AU - Teoh, T G

AU - Ziprin, Paul

AU - McIntosh, Stuart

AU - Boland, Michael R

AU - Leff, Daniel Richard

AU - Fairhurst, Katherine J

PY - 2024/1/3

Y1 - 2024/1/3

N2 - BACKGROUND: The aim of this multicentre prospective audit was to describe the current practice in the management of mastitis and breast abscesses in the UK and Ireland, with a specific focus on rates of surgical intervention.METHODS: This audit was conducted in two phases from August 2020 to August 2021; a phase 1 practice survey and a phase 2 prospective audit. Primary outcome measurements for phase 2 included patient management pathway characteristics and treatment type (medical/radiological/surgical).RESULTS: A total of 69 hospitals participated in phase 2 (1312 patients). The key findings were a high overall rate of incision and drainage (21.0 per cent) and a lower than anticipated proportion of ultrasound-guided aspiration of breast abscesses (61.0 per cent). Significant variations were observed regarding the rate of incision and drainage (range 0-100 per cent; P < 0.001) and the rate of needle aspiration (range 12.5-100 per cent; P < 0.001) between individual units. Overall, 22.5 per cent of patients were admitted for inpatient treatment, out of whom which 72.9 per cent were commenced on intravenous antibiotics. The odds of undergoing incision and drainage for a breast abscess or being admitted for inpatient treatment were significantly higher if patients presented at the weekend compared with a weekday (P ≤ 0.023). Breast specialists reviewed 40.9 per cent of all patients directly, despite the majority of patients (74.2 per cent) presenting within working hours on weekdays.CONCLUSIONS: Variation in practice exists in the management of mastitis and breast abscesses, with high rates of incision and drainage in certain regions of the UK. There is an urgent need for a national best-practice toolbox to minimize practice variation and standardize patient care.

AB - BACKGROUND: The aim of this multicentre prospective audit was to describe the current practice in the management of mastitis and breast abscesses in the UK and Ireland, with a specific focus on rates of surgical intervention.METHODS: This audit was conducted in two phases from August 2020 to August 2021; a phase 1 practice survey and a phase 2 prospective audit. Primary outcome measurements for phase 2 included patient management pathway characteristics and treatment type (medical/radiological/surgical).RESULTS: A total of 69 hospitals participated in phase 2 (1312 patients). The key findings were a high overall rate of incision and drainage (21.0 per cent) and a lower than anticipated proportion of ultrasound-guided aspiration of breast abscesses (61.0 per cent). Significant variations were observed regarding the rate of incision and drainage (range 0-100 per cent; P < 0.001) and the rate of needle aspiration (range 12.5-100 per cent; P < 0.001) between individual units. Overall, 22.5 per cent of patients were admitted for inpatient treatment, out of whom which 72.9 per cent were commenced on intravenous antibiotics. The odds of undergoing incision and drainage for a breast abscess or being admitted for inpatient treatment were significantly higher if patients presented at the weekend compared with a weekday (P ≤ 0.023). Breast specialists reviewed 40.9 per cent of all patients directly, despite the majority of patients (74.2 per cent) presenting within working hours on weekdays.CONCLUSIONS: Variation in practice exists in the management of mastitis and breast abscesses, with high rates of incision and drainage in certain regions of the UK. There is an urgent need for a national best-practice toolbox to minimize practice variation and standardize patient care.

KW - Female

KW - Humans

KW - Abscess/surgery

KW - Breast Diseases/surgery

KW - Ireland/epidemiology

KW - Mastitis/therapy

KW - Drainage

KW - United Kingdom/epidemiology

U2 - 10.1093/bjs/znad333

DO - 10.1093/bjs/znad333

M3 - Article (Academic Journal)

C2 - 37930678

SN - 0007-1323

VL - 111

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 1

M1 - znad333

ER -

Mastitis and Mammary Abscess Management Audit (MAMMA) in the UK and Ireland

Abstract

Bibliographical note

Keywords

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