Mastitis and Mammary Abscess Management Audit (MAMMA) in the UK and Ireland
Authors: Courtney Alona , Clymo Jonathon , Parks Ruth , Wilkins Alexander , Brown Ruth , O’Connell Rachel , Dave Rajiv , Dillon Marianne , Fatayer Hiba , Gallimore Rachel , Gandhi Ashu , Gardiner Matthew , Harmer Victoria , Hookway Lyndsey , Irwin Gareth , Ives Charlotte , Mathers Helen , Murray Juliette , O’Leary D Peter , Patani Neill , Paterson Sophie , Potter Shelley , Prichard Ruth , Satta Giovanni , Teoh T G , Ziprin Paul , McIntosh Stuart , Boland Michael R , Leff Daniel Richard ,   the MAMMA Research Collaborative, Ahmed Ahmed , Shalaby Ahmed , Kiran Akanksha , Boucher Alexander , Ribbits Alexander , Tenovici Alexandra , Chambers Alice , Lee Alice , Bate Alison , Koh Amanda , Sharma Anita , Wignakumar Anjelli , Fullard Anna , Isaac Anna , Lawn Anneliese , Ansari Aonghus , Brodie Arjuna , Surendran Arthika , Segaran Ashvina , Abbasi Ayesha , Regan Azel , Al-Khazaali Badr , Mirshekar-Syahkal Bahar , Riogi Bahaty , Patel Benjamin , Muntean Brenda , Ertansel Buket , Downey Candice , Cullinane Carolyn , Rossborough Catherine , Kallaway Charlotte , Sirianni Chiara , Baban Chwanrow , Hollywood Ciaran , Roger Clare , McIlmunn Colin , Arora Deeksha , Chatzopoulou Despoina , Mirghani Diya , Babu Ed , Bruce Eilidh , Khalifa Eiman , Osman Elaf , Kleidi Eleftheria , Ntakomyti Eleni , Kellett Emma , Najeeb Erum , Mallidis Evangelos , Rutherford Fiona , Malcolm Francesca , Mulita Francesk , Marchitelli Gabriella , Hughes Gemma , Davis George Neelankavil , Karagiannidis Georgios , Alyahya Ghadah , Elamin Ghassan , Santoro Giovanni , Ahmed Goran , Knudsen Grace , Harris Grant , Bromley Gwen , Esack Hana , Markey Hannah , Lei Harry Yeuk Hei , Pringle Heather , Nathaniel Hedwige , Robb Henry D , Hamid Hytham K S , Elzayat Ibrahim , Handa Ishita , Rait Jaideep , Iqbal Javeria , George Jayan , Morgan Jenna , Long Jennifer , Banks Jenny , Yau Jih Dar , Stringer Joanna , Fong Joey , Maalo Joseph , Marston Josh , Silva Joshua , Massey Julia , Kirkpatrick Katharine , De Rome Katherine , Fairhurst Katherine , Campbell Katie , Gilmore Katie , Elder Kenneth , Suri Khalida , Bossi Kimberley , Majid Kiran , Farag Kyrllos , Arthur Laura , Hackney Lauren , Ragad Lilia , Walsh Livia , Maraqa Loaie , Alder Louise , Gossling Lucy , Verebcean Marina , D'Auria Marta , Devine Michael , Flanagan Michael , Jones Michael , Kelly Michael , Reeves Monica , Rezacova Monika , Hashmi Muhammad , Win Myat , Fairhurst Natalie , Hirst Natalie , Holford Nicholas , Cook Nicola , Scally Norah , Stanilov Noyko , Nurmahomed Nur , Oyende Olamide , Olayinka Olaniyi , Chen Qian , Foster Rachel , Lee Rachel , Merh Radhika , Karmarkar Rahi , Bichoo Raouef Ahmed , Abdelrahman Rashad , Verma Rashmi , Llewellyn-Bennett Rebecca , Sharma Rishabha , Rampal Ritika , Tully Róisín , Rashid Sabina , Elbakri Sabreen , Jeffreys Sam , Muktar Samantha , Baxter Samuel , Gibbins Sarah , Qureshi Shahnaz , Chopra Sharat , Razdan Shiveta , Pilgrim Simon , Rajan Sreekumar Sundara , Bhatti Sumbal , Saha Sunita , Shah Syed Noor Hussain , Grainger Tabitha , Arif Tahera , Kiernan Tamara , Gandamihardja Tasha , Picton-Scott Thalia , Hubbard Thomas , Murphy Titus , Seddon Tom , Graja Tomasz , Kanani Trisha , Jain Urvashi , Amin Verda , Narbad Vijay , Barber Zoe , Chia Zoe 
Published: November 2023

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 &lt; 0.001) and the rate of needle aspiration (range 12.5–100 per cent; P &lt; 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.