Abstract
Objective: Our objectives were to examine whether hospital characteristics are associated with lower-and higher-than-expected sentinel lymph node biopsy (SLNB) positivity rates and whether hospitals with lower-or higherthan-expected SLNB positivity rates have worse patient outcomes. Background: Surgeon and pathologist SLNB technical errors may lead to incorrect melanoma staging. A hospital's SLNB positivity rate may reflect its SLNB proficiency for melanoma, but this has never been investigated. Methods: Stage IA-III melanoma patients undergoing SLNB were identified from the National Cancer Data Base (2004-2010). Hospital-level SLNB positivity rates were adjusted for patient-and tumor factors. Hospitals were divided into terciles of adjusted SLNB positivity rates. Hospital characteristics (using multinomial logistic regression) and survival (using Cox modeling) were examined across terciles. Results: Of 33,639 SLNB patients (from 646 hospitals), 2916 (8.7%) had at least 1 positive lymph node. Hospitals with lower-(low tercile) and higherthan-expected (high tercile) SLNB positivity rates were more likely to be lowvolume hospitals (low tercile: relative risk ratio (RRR)=2.57, P=0.002; high tercile: RRR=2.3, P=0.004) compared to hospitals with expected rates (middle tercile). Stage I patients treated at lower-than-expected SLNB positivity rate hospitals had worse 5-year survival than those treated at expected SLNB positivity rate hospitals (90.0% vs 91.9%, P=0.014; hazard ratio=1.28, 95% CI: 1.05-1.57); survival differences were not observed by SLNB positivity rates for stage II/III. Conclusions: Adjusted hospital SLNB positivity rates varied widely. Surgery at hospitals with lower-than-expected SLNB positivity rates was associated with decreased survival. Hospital SLNB positivity rates may be a novel measure to confidentially report to hospitals for internal quality assessment.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 392-398 |
| Number of pages | 7 |
| Journal | Annals of Surgery |
| Volume | 263 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jan 1 2016 |
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Keywords
- Low-volume hospitals
- National Cancer Data Base
- Quality improvement
- Sentinel lymph node biopsy
- Survival
ASJC Scopus subject areas
- Surgery
Cite this
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Adjusted hospital sentinel lymph node positivity rates in melanoma a novel potential measure of quality. / Kinnier, Christine V.; Paruch, Jennifer L.; Dahlke, Allison R.; Wayne, Jeffrey D; Benson III, Al B; Winchester, David P.; Bilimoria, Karl Y.
In: Annals of Surgery, Vol. 263, No. 2, 01.01.2016, p. 392-398.Research output: Contribution to journal › Article
TY - JOUR
T1 - Adjusted hospital sentinel lymph node positivity rates in melanoma a novel potential measure of quality
AU - Kinnier, Christine V.
AU - Paruch, Jennifer L.
AU - Dahlke, Allison R.
AU - Wayne, Jeffrey D
AU - Benson III, Al B
AU - Winchester, David P.
AU - Bilimoria, Karl Y
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Objective: Our objectives were to examine whether hospital characteristics are associated with lower-and higher-than-expected sentinel lymph node biopsy (SLNB) positivity rates and whether hospitals with lower-or higherthan-expected SLNB positivity rates have worse patient outcomes. Background: Surgeon and pathologist SLNB technical errors may lead to incorrect melanoma staging. A hospital's SLNB positivity rate may reflect its SLNB proficiency for melanoma, but this has never been investigated. Methods: Stage IA-III melanoma patients undergoing SLNB were identified from the National Cancer Data Base (2004-2010). Hospital-level SLNB positivity rates were adjusted for patient-and tumor factors. Hospitals were divided into terciles of adjusted SLNB positivity rates. Hospital characteristics (using multinomial logistic regression) and survival (using Cox modeling) were examined across terciles. Results: Of 33,639 SLNB patients (from 646 hospitals), 2916 (8.7%) had at least 1 positive lymph node. Hospitals with lower-(low tercile) and higherthan-expected (high tercile) SLNB positivity rates were more likely to be lowvolume hospitals (low tercile: relative risk ratio (RRR)=2.57, P=0.002; high tercile: RRR=2.3, P=0.004) compared to hospitals with expected rates (middle tercile). Stage I patients treated at lower-than-expected SLNB positivity rate hospitals had worse 5-year survival than those treated at expected SLNB positivity rate hospitals (90.0% vs 91.9%, P=0.014; hazard ratio=1.28, 95% CI: 1.05-1.57); survival differences were not observed by SLNB positivity rates for stage II/III. Conclusions: Adjusted hospital SLNB positivity rates varied widely. Surgery at hospitals with lower-than-expected SLNB positivity rates was associated with decreased survival. Hospital SLNB positivity rates may be a novel measure to confidentially report to hospitals for internal quality assessment.
AB - Objective: Our objectives were to examine whether hospital characteristics are associated with lower-and higher-than-expected sentinel lymph node biopsy (SLNB) positivity rates and whether hospitals with lower-or higherthan-expected SLNB positivity rates have worse patient outcomes. Background: Surgeon and pathologist SLNB technical errors may lead to incorrect melanoma staging. A hospital's SLNB positivity rate may reflect its SLNB proficiency for melanoma, but this has never been investigated. Methods: Stage IA-III melanoma patients undergoing SLNB were identified from the National Cancer Data Base (2004-2010). Hospital-level SLNB positivity rates were adjusted for patient-and tumor factors. Hospitals were divided into terciles of adjusted SLNB positivity rates. Hospital characteristics (using multinomial logistic regression) and survival (using Cox modeling) were examined across terciles. Results: Of 33,639 SLNB patients (from 646 hospitals), 2916 (8.7%) had at least 1 positive lymph node. Hospitals with lower-(low tercile) and higherthan-expected (high tercile) SLNB positivity rates were more likely to be lowvolume hospitals (low tercile: relative risk ratio (RRR)=2.57, P=0.002; high tercile: RRR=2.3, P=0.004) compared to hospitals with expected rates (middle tercile). Stage I patients treated at lower-than-expected SLNB positivity rate hospitals had worse 5-year survival than those treated at expected SLNB positivity rate hospitals (90.0% vs 91.9%, P=0.014; hazard ratio=1.28, 95% CI: 1.05-1.57); survival differences were not observed by SLNB positivity rates for stage II/III. Conclusions: Adjusted hospital SLNB positivity rates varied widely. Surgery at hospitals with lower-than-expected SLNB positivity rates was associated with decreased survival. Hospital SLNB positivity rates may be a novel measure to confidentially report to hospitals for internal quality assessment.
KW - Low-volume hospitals
KW - National Cancer Data Base
KW - Quality improvement
KW - Sentinel lymph node biopsy
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=84955713927&partnerID=8YFLogxK
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U2 - 10.1097/SLA.0000000000001052
DO - 10.1097/SLA.0000000000001052
M3 - Article
VL - 263
SP - 392
EP - 398
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 2
ER -