Institutional variation in surgical care for early-stage breast cancer at community hospitals. J Surg Res 2017 May 01;211:196-205
Date
05/16/2017Pubmed ID
28501117Pubmed Central ID
PMC5812011DOI
10.1016/j.jss.2016.11.065Scopus ID
2-s2.0-85009237702 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
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.
Author List
Dodgion CM, Lipsitz SR, Decker MR, Hu YY, Quamme SRP, Karcz A, D'Avolio L, Greenberg CCAuthor
Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAge Factors
Aged
Aged, 80 and over
Breast Neoplasms
Female
Health Services Accessibility
Healthcare Disparities
Hospitals, Community
Humans
Logistic Models
Mammaplasty
Mastectomy
Middle Aged
Practice Patterns, Physicians'
Retrospective Studies
United States
