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



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.



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).



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.
Department of Public Health Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA. adan_becerra@urmc.rochester.edu.|Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA. adan_becerra@urmc.rochester.edu.
Adan Z
AZ
Becerra
Department of Laboratory Medicine, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA.
Mariana E
ME
Berho
Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Christian P
CP
Probst
Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Christopher T
CT
Aquina
Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Mohamedtaki A
MA
Tejani
Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Maynor G
MG
Gonzalez
Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Zhaomin
Z
Xu
Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Alex A
AA
Swanger
Department of Public Health Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.|Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Katia
K
Noyes
Florida Hospital Medical Group, Florida Hospital, Center for Colon and Rectal Surgery, Orlando, FL, USA.
John R
JR
Monson
Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Fergal J
FJ
Fleming
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000706:statistics & numerical data; D044683:Colon, Descending / Q000601:surgery; D012809:Colon, Sigmoid / Q000601:surgery; D003110:Colonic Neoplasms / Q000473:pathology*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D061847:Hospitals, High-Volume / Q000592:standards / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000592:standards / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000592:standards* / Q000706:statistics & numerical data*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D012737:Sex Factors; D015996:Survival Rate