Variation in lymph node assessment after pancreatic cancer resection: Patient, surgeon, pathologist, or hospital? - 10/02/25
Abstract |
Background |
We sought to define individual contributions at the patient, surgeon, pathologist, and hospital levels on lymph node assessment after pancreatic cancer resection.
Methods |
SEER-Medicare beneficiaries who underwent pancreatic cancer resection were identified. Multi-level multivariable regression was performed to assess the proportion of variance explained by patient, surgeon, pathologist, and hospitals on lymph node assessment (≥12 versus <12).
Results |
2872 patients underwent pancreaticoduodenectomy by 646 distinct surgeons and 1063 distinct pathologists across 308 hospitals. Patient-related characteristics contributed the most to the variance in adequate lymph node assessment (71.0 %). After accounting for all explanatory variables in the full model, 5.5 % of the residual provider-level variation was attributed to the pathologist, 35.2 % to the surgeon, and 59.3 % to the hospital.
Conclusions |
Patient-to-patient variation was the greatest underlying contributor to variations in adequate lymph node assessment related to pancreatic cancer surgery. Variation among hospitals was greater than among surgeons or pathologists.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Examination of >= 12 LN post-pancreatic cancer resection is a quality-of-care benchmark, yet adherence fluctuates widely. |
• | Patient-to-patient variation was the greatest underlying contributor to variations in adequate lymph node assessment. |
• | Modifiable variation was greater at the hospital-level than among surgeons or pathologists. |
• | Using LN count as a provider performance metric may be unjustified, as most variation occurs at the patient level, not provider or institution. |
Keywords : Lymph node, Variance, Oncologic care, Patient characteristics
Plan
Vol 241
Article 116067- mars 2025 Retour au numéro
Article précédent
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