Adjusted hospital sentinel lymph node positivity rates in melanoma a novel potential measure of quality

Christine V. Kinnier, Jennifer L. Paruch, Allison R. Dahlke, Jeffrey D Wayne, Al B Benson III, David P. Winchester, Karl Y Bilimoria

Research output: Contribution to journalArticle

7 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)392-398
Number of pages7
JournalAnnals of Surgery
Volume263
Issue number2
DOIs
StatePublished - Jan 1 2016

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Sentinel Lymph Node Biopsy
Melanoma
Survival
Sentinel Lymph Node
Odds Ratio

Keywords

  • Low-volume hospitals
  • National Cancer Data Base
  • Quality improvement
  • Sentinel lymph node biopsy
  • Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Kinnier, Christine V. ; Paruch, Jennifer L. ; Dahlke, Allison R. ; Wayne, Jeffrey D ; Benson III, Al B ; Winchester, David P. ; Bilimoria, Karl Y. / Adjusted hospital sentinel lymph node positivity rates in melanoma a novel potential measure of quality. In: Annals of Surgery. 2016 ; Vol. 263, No. 2. pp. 392-398.
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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.",
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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 journalArticle

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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

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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

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