Variation in Hospital-Specific Rates of Suboptimal Lymphadenectomy and Survival in Colon Cancer: Evidence from the National Cancer Data Base
Background Little is known about between-hospital differences in the rate of suboptimal lymphadenectomy. This study characterizes variation in hospital-specific rates of suboptimal lymphadenectomy and its effect on overall survival in a national hospital-based registry. Methods Stage I–III colon can...
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| Veröffentlicht in: | Annals of surgical oncology 2016-12, Vol.23 (Suppl 5), p.674-683 |
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| creator | Becerra, Adan Z. Berho, Mariana E. Probst, Christian P. Aquina, Christopher T. Tejani, Mohamedtaki A. Gonzalez, Maynor G. Xu, Zhaomin Swanger, Alex A. Noyes, Katia Monson, John R. Fleming, Fergal J. |
| description | Background
Little is known about between-hospital differences in the rate of suboptimal lymphadenectomy. This study characterizes variation in hospital-specific rates of suboptimal lymphadenectomy and its effect on overall survival in a national hospital-based registry.
Methods
Stage I–III colon cancer patients were identified from the 2003–2012 National Cancer Data Base. Bayesian multilevel logistic regression models were used to assess the impact of patient- and hospital-level factors on hospital-specific rates of suboptimal lymphadenectomy ( |
| doi_str_mv | 10.1245/s10434-016-5551-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1852655787</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4275320561</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-512f385c2c904c61f3665bd6e4728afeac6887a9a3f72b6d50504b4ee071093a3</originalsourceid><addsrcrecordid>eNp1kc2KFTEQhYMozjj6AG4k4MZNa_6T606v8yNcFBx1G9LpipOhu9Mm3RfuO_jQ5tqjiOCqQp2vToU6CD2l5CVlQr4qlAguGkJVI6WkDbuHTqmsHaEMvV_fRJlmw5Q8QY9KuSWEak7kQ3TCtKJcSnOKfnx1Obo5phHHEV-lMsXZ9c31BD6G6PEnN0PBKeDrpU3THAfX491hmG5cByP4OQ0H7Mauynkf91WsLtvUV7utGz3k1_h8HyvqAYecBjzfAP7wa19lVwS_c7PDb12Bx-hBcH2BJ3f1DH25OP-8vWp2Hy_fb9_sGs81mxtJWeBGeuY3RHhFA1dKtp0CoZlxAZxXxmi3cTxo1qpOEklEKwCIpmTDHT9DL1bfKafvC5TZDrF46Hs3QlqKpUbWo0ltdEWf_4PepiXXzx8pobUyXIpK0ZXyOZWSIdgp11Plg6XEHqOya1S2RmWPUVlWZ57dOS_tAN2fid_ZVICtQKnS-A3yX6v_6_oT8L2ehQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1847768354</pqid></control><display><type>article</type><title>Variation in Hospital-Specific Rates of Suboptimal Lymphadenectomy and Survival in Colon Cancer: Evidence from the National Cancer Data Base</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Becerra, Adan Z. ; Berho, Mariana E. ; Probst, Christian P. ; Aquina, Christopher T. ; Tejani, Mohamedtaki A. ; Gonzalez, Maynor G. ; Xu, Zhaomin ; Swanger, Alex A. ; Noyes, Katia ; Monson, John R. ; Fleming, Fergal J.</creator><creatorcontrib>Becerra, Adan Z. ; Berho, Mariana E. ; Probst, Christian P. ; Aquina, Christopher T. ; Tejani, Mohamedtaki A. ; Gonzalez, Maynor G. ; Xu, Zhaomin ; Swanger, Alex A. ; Noyes, Katia ; Monson, John R. ; Fleming, Fergal J.</creatorcontrib><description>Background
Little is known about between-hospital differences in the rate of suboptimal lymphadenectomy. This study characterizes variation in hospital-specific rates of suboptimal lymphadenectomy and its effect on overall survival in a national hospital-based registry.
Methods
Stage I–III colon cancer patients were identified from the 2003–2012 National Cancer Data Base. Bayesian multilevel logistic regression models were used to assess the impact of patient- and hospital-level factors on hospital-specific rates of suboptimal lymphadenectomy (<12 lymph nodes), and multilevel Cox models were used to estimate the effect of suboptimal lymphadenectomy at the patient (yes vs. no) and hospital level (quartiles of hospital-specific rates) on overall survival.
Results
A total of 360,846 patients across 1345 hospitals in the US met the inclusion criteria, of which 25 % had a suboptimal lymphadenectomy. Wide variation was observed in hospital-specific rates of suboptimal lymphadenectomy (range 0–82 %, median 44 %). Older age, male sex, comorbidity score, no insurance, positive margins, lower tumor grade, lower T and N stage, and sigmoid and left colectomy were associated with higher odds of suboptimal lymphadenectomy. Patients treated at lower-volume and non-academic hospitals had higher odds of suboptimal lymphadenectomy. Patient- and hospital-level factors explained 5 % of the between-hospital variability in suboptimal lymphadenectomy, leaving 95 % unexplained. Higher suboptimal lymphadenectomy rates were associated with worse survival (quartile 4 vs. quartile 1: hazard ratio 1.19, 95 % confidence interval 1.16–1.22).
Conclusion
Large differences in hospital-specific rates of suboptimal lymphadenectomy were observed, and this variation was associated with survival. Quality improvement initiatives targeting hospital-level adherence to the national standard may improve overall survival among resected colon cancer patients.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-016-5551-2</identifier><identifier>PMID: 27613558</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject><![CDATA[Age Factors ; Aged ; Aged, 80 and over ; Colectomy - statistics & numerical data ; Colon, Descending - surgery ; Colon, Sigmoid - surgery ; Colonic Neoplasms - pathology ; Colorectal Cancer ; Comorbidity ; Databases, Factual ; Female ; Hospitals, High-Volume - standards ; Hospitals, High-Volume - statistics & numerical data ; Hospitals, Low-Volume - standards ; Hospitals, Low-Volume - statistics & numerical data ; Hospitals, Teaching - standards ; Hospitals, Teaching - statistics & numerical data ; Humans ; Insurance, Health - statistics & numerical data ; Lymph Node Excision - standards ; Lymph Node Excision - statistics & numerical data ; Lymphatic Metastasis ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Oncology ; Sex Factors ; Surgery ; Surgical Oncology ; Survival Rate]]></subject><ispartof>Annals of surgical oncology, 2016-12, Vol.23 (Suppl 5), p.674-683</ispartof><rights>Society of Surgical Oncology 2016</rights><rights>Annals of Surgical Oncology is a copyright of Springer, 2016.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-512f385c2c904c61f3665bd6e4728afeac6887a9a3f72b6d50504b4ee071093a3</citedby><cites>FETCH-LOGICAL-c372t-512f385c2c904c61f3665bd6e4728afeac6887a9a3f72b6d50504b4ee071093a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-016-5551-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-016-5551-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27613558$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Becerra, Adan Z.</creatorcontrib><creatorcontrib>Berho, Mariana E.</creatorcontrib><creatorcontrib>Probst, Christian P.</creatorcontrib><creatorcontrib>Aquina, Christopher T.</creatorcontrib><creatorcontrib>Tejani, Mohamedtaki A.</creatorcontrib><creatorcontrib>Gonzalez, Maynor G.</creatorcontrib><creatorcontrib>Xu, Zhaomin</creatorcontrib><creatorcontrib>Swanger, Alex A.</creatorcontrib><creatorcontrib>Noyes, Katia</creatorcontrib><creatorcontrib>Monson, John R.</creatorcontrib><creatorcontrib>Fleming, Fergal J.</creatorcontrib><title>Variation in Hospital-Specific Rates of Suboptimal Lymphadenectomy and Survival in Colon Cancer: Evidence from the National Cancer Data Base</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
Little is known about between-hospital differences in the rate of suboptimal lymphadenectomy. This study characterizes variation in hospital-specific rates of suboptimal lymphadenectomy and its effect on overall survival in a national hospital-based registry.
Methods
Stage I–III colon cancer patients were identified from the 2003–2012 National Cancer Data Base. Bayesian multilevel logistic regression models were used to assess the impact of patient- and hospital-level factors on hospital-specific rates of suboptimal lymphadenectomy (<12 lymph nodes), and multilevel Cox models were used to estimate the effect of suboptimal lymphadenectomy at the patient (yes vs. no) and hospital level (quartiles of hospital-specific rates) on overall survival.
Results
A total of 360,846 patients across 1345 hospitals in the US met the inclusion criteria, of which 25 % had a suboptimal lymphadenectomy. Wide variation was observed in hospital-specific rates of suboptimal lymphadenectomy (range 0–82 %, median 44 %). Older age, male sex, comorbidity score, no insurance, positive margins, lower tumor grade, lower T and N stage, and sigmoid and left colectomy were associated with higher odds of suboptimal lymphadenectomy. Patients treated at lower-volume and non-academic hospitals had higher odds of suboptimal lymphadenectomy. Patient- and hospital-level factors explained 5 % of the between-hospital variability in suboptimal lymphadenectomy, leaving 95 % unexplained. Higher suboptimal lymphadenectomy rates were associated with worse survival (quartile 4 vs. quartile 1: hazard ratio 1.19, 95 % confidence interval 1.16–1.22).
Conclusion
Large differences in hospital-specific rates of suboptimal lymphadenectomy were observed, and this variation was associated with survival. Quality improvement initiatives targeting hospital-level adherence to the national standard may improve overall survival among resected colon cancer patients.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Colectomy - statistics & numerical data</subject><subject>Colon, Descending - surgery</subject><subject>Colon, Sigmoid - surgery</subject><subject>Colonic Neoplasms - pathology</subject><subject>Colorectal Cancer</subject><subject>Comorbidity</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Hospitals, High-Volume - standards</subject><subject>Hospitals, High-Volume - statistics & numerical data</subject><subject>Hospitals, Low-Volume - standards</subject><subject>Hospitals, Low-Volume - statistics & numerical data</subject><subject>Hospitals, Teaching - standards</subject><subject>Hospitals, Teaching - statistics & numerical data</subject><subject>Humans</subject><subject>Insurance, Health - statistics & numerical data</subject><subject>Lymph Node Excision - standards</subject><subject>Lymph Node Excision - statistics & numerical data</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasm Grading</subject><subject>Neoplasm Staging</subject><subject>Oncology</subject><subject>Sex Factors</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival Rate</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kc2KFTEQhYMozjj6AG4k4MZNa_6T606v8yNcFBx1G9LpipOhu9Mm3RfuO_jQ5tqjiOCqQp2vToU6CD2l5CVlQr4qlAguGkJVI6WkDbuHTqmsHaEMvV_fRJlmw5Q8QY9KuSWEak7kQ3TCtKJcSnOKfnx1Obo5phHHEV-lMsXZ9c31BD6G6PEnN0PBKeDrpU3THAfX491hmG5cByP4OQ0H7Mauynkf91WsLtvUV7utGz3k1_h8HyvqAYecBjzfAP7wa19lVwS_c7PDb12Bx-hBcH2BJ3f1DH25OP-8vWp2Hy_fb9_sGs81mxtJWeBGeuY3RHhFA1dKtp0CoZlxAZxXxmi3cTxo1qpOEklEKwCIpmTDHT9DL1bfKafvC5TZDrF46Hs3QlqKpUbWo0ltdEWf_4PepiXXzx8pobUyXIpK0ZXyOZWSIdgp11Plg6XEHqOya1S2RmWPUVlWZ57dOS_tAN2fid_ZVICtQKnS-A3yX6v_6_oT8L2ehQ</recordid><startdate>20161201</startdate><enddate>20161201</enddate><creator>Becerra, Adan Z.</creator><creator>Berho, Mariana E.</creator><creator>Probst, Christian P.</creator><creator>Aquina, Christopher T.</creator><creator>Tejani, Mohamedtaki A.</creator><creator>Gonzalez, Maynor G.</creator><creator>Xu, Zhaomin</creator><creator>Swanger, Alex A.</creator><creator>Noyes, Katia</creator><creator>Monson, John R.</creator><creator>Fleming, Fergal J.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20161201</creationdate><title>Variation in Hospital-Specific Rates of Suboptimal Lymphadenectomy and Survival in Colon Cancer: Evidence from the National Cancer Data Base</title><author>Becerra, Adan Z. ; Berho, Mariana E. ; Probst, Christian P. ; Aquina, Christopher T. ; Tejani, Mohamedtaki A. ; Gonzalez, Maynor G. ; Xu, Zhaomin ; Swanger, Alex A. ; Noyes, Katia ; Monson, John R. ; Fleming, Fergal J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-512f385c2c904c61f3665bd6e4728afeac6887a9a3f72b6d50504b4ee071093a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Colectomy - statistics & numerical data</topic><topic>Colon, Descending - surgery</topic><topic>Colon, Sigmoid - surgery</topic><topic>Colonic Neoplasms - pathology</topic><topic>Colorectal Cancer</topic><topic>Comorbidity</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Hospitals, High-Volume - standards</topic><topic>Hospitals, High-Volume - statistics & numerical data</topic><topic>Hospitals, Low-Volume - standards</topic><topic>Hospitals, Low-Volume - statistics & numerical data</topic><topic>Hospitals, Teaching - standards</topic><topic>Hospitals, Teaching - statistics & numerical data</topic><topic>Humans</topic><topic>Insurance, Health - statistics & numerical data</topic><topic>Lymph Node Excision - standards</topic><topic>Lymph Node Excision - statistics & numerical data</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoplasm Grading</topic><topic>Neoplasm Staging</topic><topic>Oncology</topic><topic>Sex Factors</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Becerra, Adan Z.</creatorcontrib><creatorcontrib>Berho, Mariana E.</creatorcontrib><creatorcontrib>Probst, Christian P.</creatorcontrib><creatorcontrib>Aquina, Christopher T.</creatorcontrib><creatorcontrib>Tejani, Mohamedtaki A.</creatorcontrib><creatorcontrib>Gonzalez, Maynor G.</creatorcontrib><creatorcontrib>Xu, Zhaomin</creatorcontrib><creatorcontrib>Swanger, Alex A.</creatorcontrib><creatorcontrib>Noyes, Katia</creatorcontrib><creatorcontrib>Monson, John R.</creatorcontrib><creatorcontrib>Fleming, Fergal J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Becerra, Adan Z.</au><au>Berho, Mariana E.</au><au>Probst, Christian P.</au><au>Aquina, Christopher T.</au><au>Tejani, Mohamedtaki A.</au><au>Gonzalez, Maynor G.</au><au>Xu, Zhaomin</au><au>Swanger, Alex A.</au><au>Noyes, Katia</au><au>Monson, John R.</au><au>Fleming, Fergal J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Variation in Hospital-Specific Rates of Suboptimal Lymphadenectomy and Survival in Colon Cancer: Evidence from the National Cancer Data Base</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2016-12-01</date><risdate>2016</risdate><volume>23</volume><issue>Suppl 5</issue><spage>674</spage><epage>683</epage><pages>674-683</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
Little is known about between-hospital differences in the rate of suboptimal lymphadenectomy. This study characterizes variation in hospital-specific rates of suboptimal lymphadenectomy and its effect on overall survival in a national hospital-based registry.
Methods
Stage I–III colon cancer patients were identified from the 2003–2012 National Cancer Data Base. Bayesian multilevel logistic regression models were used to assess the impact of patient- and hospital-level factors on hospital-specific rates of suboptimal lymphadenectomy (<12 lymph nodes), and multilevel Cox models were used to estimate the effect of suboptimal lymphadenectomy at the patient (yes vs. no) and hospital level (quartiles of hospital-specific rates) on overall survival.
Results
A total of 360,846 patients across 1345 hospitals in the US met the inclusion criteria, of which 25 % had a suboptimal lymphadenectomy. Wide variation was observed in hospital-specific rates of suboptimal lymphadenectomy (range 0–82 %, median 44 %). Older age, male sex, comorbidity score, no insurance, positive margins, lower tumor grade, lower T and N stage, and sigmoid and left colectomy were associated with higher odds of suboptimal lymphadenectomy. Patients treated at lower-volume and non-academic hospitals had higher odds of suboptimal lymphadenectomy. Patient- and hospital-level factors explained 5 % of the between-hospital variability in suboptimal lymphadenectomy, leaving 95 % unexplained. Higher suboptimal lymphadenectomy rates were associated with worse survival (quartile 4 vs. quartile 1: hazard ratio 1.19, 95 % confidence interval 1.16–1.22).
Conclusion
Large differences in hospital-specific rates of suboptimal lymphadenectomy were observed, and this variation was associated with survival. Quality improvement initiatives targeting hospital-level adherence to the national standard may improve overall survival among resected colon cancer patients.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>27613558</pmid><doi>10.1245/s10434-016-5551-2</doi><tpages>10</tpages></addata></record> |
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| subjects | Age Factors Aged Aged, 80 and over Colectomy - statistics & numerical data Colon, Descending - surgery Colon, Sigmoid - surgery Colonic Neoplasms - pathology Colorectal Cancer Comorbidity Databases, Factual Female Hospitals, High-Volume - standards Hospitals, High-Volume - statistics & numerical data Hospitals, Low-Volume - standards Hospitals, Low-Volume - statistics & numerical data Hospitals, Teaching - standards Hospitals, Teaching - statistics & numerical data Humans Insurance, Health - statistics & numerical data Lymph Node Excision - standards Lymph Node Excision - statistics & numerical data Lymphatic Metastasis Male Medicine Medicine & Public Health Middle Aged Neoplasm Grading Neoplasm Staging Oncology Sex Factors Surgery Surgical Oncology Survival Rate |
| title | Variation in Hospital-Specific Rates of Suboptimal Lymphadenectomy and Survival in Colon Cancer: Evidence from the National Cancer Data Base |
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