Variation in Hospital-Specific Rates of Suboptimal Lymphadenectomy and Survival in Colon Cancer: Evidence from the National Cancer Data Base

• Published in: Annals of surgical oncology Vol. 23; no. Suppl 5; pp. 674 - 683
• Main Authors: 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.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2016; Springer Nature B.V
• 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; National Cancer Data; Multilevel Logistic Regression Model; Propensity Score; Colon Cancer Patient; National Cancer Data Base
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-016-5551-2

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.