• Annals of surgery · Dec 2022

    De-Implementation of Axillary Dissection in Women with Breast Cancer is Largely Driven By Site-Level Contextual Effects.

    • Ana L Gleisner, Angela Moss, Chloe Friedman, Krithika Suresh, Gary Grunwald, Robert J Torphy, Laura D Leonard, Kathryn Colborn, Gretchen Ahrendt, Sarah Tevis, Nicole Christian, Viviane L Abud, Thiago B de Araujo, Laurel E Beaty, Daniel Thieu, Thomas J Glorioso, Simon Kim, and Stade Daugherty.
    • Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
    • Ann. Surg. 2022 Dec 1; 276 (6): e923e931e923-e931.

    ObjectiveTo assess the contribution of unknown institutional factors (contextual effects) in the de-implementation of cALND in women with breast cancer.Summary Of Background DataWomen included in the National Cancer Database with invasive breast carcinoma from 2012 to 2016 that underwent upfront lumpectomy and were found to have a positive sentinel node.MethodsA multivariable mixed effects logistic regression model with a random intercept for site was used to determine the effect of patient, tumor, and institutional variables on the risk of cALND. Reference effect measureswere used to describe and compare the contribution of contextual effects to the variation in cALND use to that of measured variables.ResultsBy 2016, cALND was still performed in at least 50% of the patients in a quarter of the institutions. Black race, younger women and those with larger or hormone negative tumors were more likely to undergo cALND. However, the width of the 90% reference effect measures range for the contextual effects exceeded that of the measured site, tumor, time, and patient demographics, suggesting institutional contextual effects were the major drivers of cALND de-implementation. For instance, a woman at an institution with low-risk of performing cALND would have 74% reduced odds of havinga cALND than if she was treated at a median-risk institution, while a patient at a high-risk institution had 3.91 times the odds.ConclusionCompared to known patient, tumor, and institutional factors, contextual effects had a higher contribution to the variation in cALND use.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…