Tools for measuring quality of care in breast surgery

Breast cancer is the most common malignancy in women, and surgery remains a cornerstone of treatment. Traditional quality indicators, such as complication or margin status, often fail to capture the overall quality of surgical care. In recent years, indicators such as Textbook Outcomes (TO) and benchmarking (BM) have been proposed to provide a more comprehensive assessment. We conducted a systematic review, registered in PROSPERO (CRD420251131786), following PRISMA guidelines, to evaluate their role in breast cancer surgery. A total of 344 studies were screened, and seven were included (four addressing TO and three BM). TO was defined by negative margins, adequate lymph node dissection, no 30-day mortality or readmission, and no prolonged hospital stay, was consistently associated with improved overall survival. BM studies revealed significant interhospital variability and opportunities for improvement. Both TO and BM appear promising as tools for quality evaluation, but international consensus and prospective validation are required for widespread implementation.