The New Opt-Out Dutch National Breast Implant Registry – Lessons learnt from the road to implementation

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 70; no. 10; pp. 1354 - 1360
• Main Authors: Rakhorst, Hinne A., MD PhD, Mureau, M.A.M., MD, PhD, Cooter, Rodney D., MBBS, M.D FRACS, McNeil, John, PhD, Prof, van Hooff, Miranda, M.Sc, van der Hulst, René, MD PhD Prof, Hommes, Juliette, MD PhD, Hoornweg, Marije, MD PhD, Mooijen-Zaal, Laura H., MD PhD, Liem, Patricia, MSc, Mathijssen, Irene MJ., MD PhD Prof
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-10-2017
• Subjects: Audit; Breast Implantation - adverse effects; Breast Implantation - methods; Breast Implantation - statistics & numerical data; Breast implants; Breast Implants - adverse effects; Breast Implants - statistics & numerical data; Commission on Professional and Hospital Activities - organization & administration; Female; Humans; Needs Assessment; Netherlands; Organizational Innovation; Patient registry; Patient Safety - standards; Plastic Surgery; Prosthesis Failure; Quality Improvement; Quality of Health Care - standards; Reconstruction; Registries; Value based health care; Reconstruction; Patient registry; Breast implants; Audit; Value based health care
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2017.04.003

Abstract An estimated 1-3% of all women in the Netherlands carry breast implants. Since the introduction five decades ago, problems with a variety of breast implants have emerged with direct consequences for the patients’ health. Plastic surgeons worldwide reacted through campaigning for auditing on long-term implant quality surgeon performance and institutional outcomes in implant registries. Especially the PIP implant scandal of 2010 demonstrated the paucity of epidemiological data and uncovered a weakness in our ability to even ‘track and trace’ patients. In addition, a recent report of the Dutch Institute of National Health showed a lack of compliance of 100% of breast implant producers to CE requirements. These arguments stress the need for an independent implant registry. Insufficient capture rates or dependence from the implant producers made the variety of national and international patient registries unreliable. The Dutch Breast Implant Registry is unique because it is an opt-out registry without the need for informed consent and thus a high capture rate. Furthermore, an estimated 95% of breast implants are implanted by board-certified plastic surgeons. Funding was achieved from a non-governmental organisation to increase the quality of health care in the Netherlands and maintenance is gathered by 25 euros per implant inserted. This article describes the way the Dutch have set up their system, with special attention to the well known hurdles of starting a patient registry. Examples include; funding, medical ethical issues, opt out system, benchmarking, quality assurance as well as governance and collaboration. The Dutch consider their experience and data shareware for others to be used globally to the benefit of patient safety and quality improvement.