Variation in lymph node assessment after pancreatic cancer resection: Patient, surgeon, pathologist, or hospital?

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2024-11-07 DOI:10.1016/j.amjsurg.2024.116067

Muhammad Musaab Munir, Selamawit Woldesenbet, Mujtaba Khalil, Muhammad Muntazir Mehdi Khan, Mary Dillhoff, Timothy M. Pawlik

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引用次数: 0

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.

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胰腺癌切除术后淋巴结评估的差异：患者、外科医生、病理学家还是医院？

背景：我们试图确定患者、外科医生、病理学家和医院对胰腺癌切除术后淋巴结评估的个人贡献：方法：确定了接受胰腺癌切除术的 SEER-Medicare 受益人。结果：2872 名患者在 308 家医院由 646 名不同的外科医生和 1063 名不同的病理学家进行了胰十二指肠切除术。患者相关特征对淋巴结充分评估的差异影响最大（71.0%）。在考虑了完整模型中的所有解释变量后，病理学家、外科医生和医院分别占提供者水平差异的5.5%、35.2%和59.3%：结论：患者与患者之间的差异是导致胰腺癌手术淋巴结充分评估差异的最大根本原因。医院之间的差异大于外科医生或病理学家之间的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.