TY - JOUR
T1 - Institutional variation in surgical care for early-stage breast cancer at community hospitals
AU - Dodgion, Christopher M.
AU - Lipsitz, Stuart R.
AU - Decker, Marquita R.
AU - Hu, Yue Yung
AU - Quamme, Sudha R.Pavuluri
AU - Karcz, Anita
AU - D'Avolio, Leonard
AU - Greenberg, Caprice C.
N1 - Funding Information:
This project was supported by the National Cancer Institute (RC1CA144705-03). Support for individual investigators also included the American Surgical Association Foundation (C.C.G.) and NIH training grants T32 CA009535-23 (C.M.D.), T32 DK00754-12 (Y.-Y.H.), and T32 CA090217 (M.R.D.).The authors would like to acknowledge the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) for their support.
Publisher Copyright:
© 2016
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Background There is significant institutional variation in the surgical care of breast cancer, and this may reflect access to services and resultant physician practice patterns. In previous studies, specialty care has been associated with variation in the operative treatment of breast cancer but has not been evaluated in a community setting. This study investigates these issues in a cohort of 59 community hospitals in the United States. Materials and methods Data on patients receiving an operation for breast cancer (2006-2009) in a large, geographically diverse cohort of hospitals were obtained. Administrative data, autoabstracted cancer-specific variables from free text, and multiple other data sets were combined. Polymotous logistic regression with multilevel outcomes identified associations between these variables and surgical treatment. Results At 59 community hospitals, 4766 patients underwent breast conserving surgery (BCS), mastectomy, or mastectomy with reconstruction. The older patients were most likely to receive mastectomy alone, whereas the younger age group underwent more reconstruction (age <50), and BCS was most likely in patients aged 50-65. Surgical procedure also varied according to tumor characteristics. BCS was more likely at smaller hospitals, those with ambulatory surgery centers, and those located in nonmetropolitan areas. The likelihood of reconstruction doubled when there were more reconstructive surgeons in the health services area (P = 0.02). BCS was more likely when radiation oncology services were available within the hospital or network (P = 0.04). Conclusions Interpretation of these results for practice redesign is not straightforward. Although access to specialty care is statistically associated with type of breast surgical procedure, clinical impact is limited. It may be more effective to target other aspects of care to ensure each patient receives treatment consistent with her individual preferences.
AB - Background There is significant institutional variation in the surgical care of breast cancer, and this may reflect access to services and resultant physician practice patterns. In previous studies, specialty care has been associated with variation in the operative treatment of breast cancer but has not been evaluated in a community setting. This study investigates these issues in a cohort of 59 community hospitals in the United States. Materials and methods Data on patients receiving an operation for breast cancer (2006-2009) in a large, geographically diverse cohort of hospitals were obtained. Administrative data, autoabstracted cancer-specific variables from free text, and multiple other data sets were combined. Polymotous logistic regression with multilevel outcomes identified associations between these variables and surgical treatment. Results At 59 community hospitals, 4766 patients underwent breast conserving surgery (BCS), mastectomy, or mastectomy with reconstruction. The older patients were most likely to receive mastectomy alone, whereas the younger age group underwent more reconstruction (age <50), and BCS was most likely in patients aged 50-65. Surgical procedure also varied according to tumor characteristics. BCS was more likely at smaller hospitals, those with ambulatory surgery centers, and those located in nonmetropolitan areas. The likelihood of reconstruction doubled when there were more reconstructive surgeons in the health services area (P = 0.02). BCS was more likely when radiation oncology services were available within the hospital or network (P = 0.04). Conclusions Interpretation of these results for practice redesign is not straightforward. Although access to specialty care is statistically associated with type of breast surgical procedure, clinical impact is limited. It may be more effective to target other aspects of care to ensure each patient receives treatment consistent with her individual preferences.
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U2 - 10.1016/j.jss.2016.11.065
DO - 10.1016/j.jss.2016.11.065
M3 - Article
C2 - 28501117
AN - SCOPUS:85009237702
SN - 0022-4804
VL - 211
SP - 196
EP - 205
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -