Imperial College London

Mr Daniel Richard Leff

Faculty of MedicineDepartment of Surgery & Cancer

Reader in Breast Surgery



+44 (0)20 3312 1947d.leff




Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus






BibTex format

author = {Leff, DR and Patani, N and Finn, M and Eshleby, S and Omar, A and Kaur, A and Contractor, K and Thiruchelvam, P and Curtis, S and Main, J and Cunningham, D and Hogben, K and AlMufti, R and Hadjiminas, DJ},
doi = {10.1002/bjs.10919},
journal = {British Journal of Surgery},
pages = {1615--1622},
title = {A ‘best practice’ care pathway improves management of mastitis and breast abscess},
url = {},
volume = {105},
year = {2018}

RIS format (EndNote, RefMan)

AB - Background: As a result of surgical sub-specialisation, mastitis and breast abscess may be managed with unnecessary hospitalisation, prolonged admission, variable antibiotic prescribing, incision and drainage rather than aspiration, and loss to follow-up. Objective: To evaluate a ‘best-practice’ algorithm to improve management across a multi-site NHS Trust; focusing on uniformity of antibiotic prescribing, ultrasound assessment, admission rates, length of stay, intervention by aspiration or incision and drainage, and follow-up. Methods: Management was initially evaluated in a retrospective cohort (Phase-I: “PRE-pathway”, n=53) and subsequently compared to two prospective cohorts (Phase II and III = “POST-pathway”, n=141), one immediately following pathway introduction (Phase II n=61), and a further loop-closing audit (Phase-III, n=80) to assess sustainability of quality improvements. Results: The management pathway and referral proforma improved compliance with antibiotic guidelines (Pre=34.0% vs. Post=58.2%, p<0.01), which was maintained (Phase-II=54.1% vs. III=61.3%, p=0.68) and sustainably increased ultrasound assessment (Pre=37.7% vs. Post=77.3%, p<0.001; Phase-II=75.4% vs. III=78.8%, p=0.89). Reductions in rates of incision and drainage (Pre=7.5% vs. Post=0.7%, p<0.01) were maintained (Phase-II=0% vs. III=1.3%, p=0.38), and follow-up consistently improved (Pre=43.4% vs. Post=95.7%, p<0.001; Phase-II=91.8% vs. III=98.8%, p=0.12). Reduced hospital admission (Pre=30.2% vs. Post=20.6%, p=0.25) and median length of stay [Pre=2 days (range=1-5) vs. Post=1 day (range=1-6), p=0.07] were not statistically significant.
AU - Leff,DR
AU - Patani,N
AU - Finn,M
AU - Eshleby,S
AU - Omar,A
AU - Kaur,A
AU - Contractor,K
AU - Thiruchelvam,P
AU - Curtis,S
AU - Main,J
AU - Cunningham,D
AU - Hogben,K
AU - AlMufti,R
AU - Hadjiminas,DJ
DO - 10.1002/bjs.10919
EP - 1622
PY - 2018///
SN - 1365-2168
SP - 1615
TI - A ‘best practice’ care pathway improves management of mastitis and breast abscess
T2 - British Journal of Surgery
UR -
UR -
VL - 105
ER -