Adjusted Hospital Sentinel Lymph Node Positivity Rates in Melanoma: A Novel Potential Measure of Quality

• Published in: Annals of surgery Vol. 263; no. 2; p. 392
• Main Authors: Kinnier, Christine V, Paruch, Jennifer L, Dahlke, Allison R, Wayne, Jeffrey D, Benson, 3rd, Al B, Winchester, David P, Bilimoria, Karl Y
• Format: Journal Article
• Language: English
• Published: United States 01.02.2016
• Subjects: Adult; Aged; Aged, 80 and over; Databases, Factual; Female; Hospitals - standards; Hospitals - statistics & numerical data; Humans; Logistic Models; Lymphatic Metastasis; Male; Melanoma - mortality; Melanoma - pathology; Middle Aged; Neoplasm Staging; Outcome Assessment (Health Care); Quality Indicators, Health Care - statistics & numerical data; Sentinel Lymph Node Biopsy - standards; Sentinel Lymph Node Biopsy - statistics & numerical data; Skin Neoplasms - mortality; Skin Neoplasms - pathology; United States; United States
• ISSN: 1528-1140
• DOI: 10.1097/SLA.0000000000001052

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 higher-than-expected SLNB positivity rates have worse patient outcomes. 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. 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. Of 33,639 SLNB patients (from 646 hospitals), 2916 (8.7%) had at least 1 positive lymph node. Hospitals with lower- (low tercile) and higher-than-expected (high tercile) SLNB positivity rates were more likely to be low-volume 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. 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.