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

作者：Kinnier Christine V; Paruch Jennifer L; Dahlke Allison R; Wayne Jeffrey D; Benson Al B III; Winchester David P; Bilimoria Karl Y^*

来源：Annals of Surgery, 2016, 263(2): 392-398.

DOI：10.1097/SLA.0000000000001052

• low-volume hospitals
• National Cancer Data Base
• quality improvement
• sentinel lymph node biopsy
• survival

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 higher-than-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 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.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.

• 出版日期2016-2
• 单位西北大学