Lymph Node Evaluation as a Colon Cancer Quality Measure: A National Hospital Report Card

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Abstract
Examination of 12 or more regional lymph nodes for colon cancer is associated with improved staging and survival, and the National Quality Forum recently endorsed lymph node examination for colon cancer as a quality surveillance measure. However, information regarding the extent of hospital compliance with the 12-node measure in the United States is lacking. From the National Cancer Data Base, 1296 hospitals that performed 156 789 colectomies in 1996–1997 and 2004–2005 were identified, and rates of hospital-level compliance (defined as examination of ≥12 nodes in ≥75% of patients) in these two time periods were compared. Multivariable models were developed to determine if hospital type, volume, or differences in case mix were associated with 12-node measure compliance. All statistical tests were two-sided. In 1996–1997, 15% of hospitals were compliant with the 12-node measure; in 2004–2005 the percentage of compliant hospitals had increased to 38%. From 1996–1997 to 2004–2005, 12-node measure compliance increased at 980 hospitals, remained unchanged at 6 hospitals, and decreased at 310 hospitals. In 2004–2005, National Cancer Institute–designated Comprehensive Cancer Centers were more frequently compliant with the 12-node measure than other academic hospitals, Veterans’ Administration hospitals, or community hospitals (78.1% versus 52.4%, 53.1%, and 33.7%, respectively, all P < .001), even after adjustment for differences in characteristics of the colon cancer patients at these hospitals. This study provides a national report card of nearly 1300 hospitals showing that more than 60% of institutions failed to achieve a compliance benchmark for the 12-node measure. Considerable improvement is needed in colon cancer nodal evaluation in the United States.