Abstract
We hare analysed the influence of patient and hospital characteristics and region, on the use of breast-conserving surgery (BCS) in Catalonia (Spain).
Data for this study was obtained from the Catalan Hospital Discharge Data Base. The study period was 1995–1998. The Mantel-Haenszel test was used to examine overall trends in the use of BCS. A regression analysis was performed to assess the effect of period adjusted for patient, hospital characteristics, and area of residence on use of BCS, and a multilevel analysis was performed to consider possible associations between individual and aggregate level variables.
BCS was carried out in 43% of women in the period 1995–98 and there was an increasing significant trend in its use. Multilevel analysis showed that age and hospital volume were significant predictors of the use of BCS, and hospitals with higher volumes of activity having higher rates of BCS relative to mastectomy.
Despite the evidence demonstrating the effectiveness of breast conserving surgery, there are still considerable variations in its use, which may be in part due to physician attitudes. Changes in health care organisation to deal with low volume treatments at hospital level should be
Resumen
Se ha analizado si influyen las características del paciente, del hospital y de la región en la utilización de la cirugía conservadora de mama (CCM) en Cataluña (España).
Los datos para este estudio se han obtenido de la base de datos del Informe de Alta Hospitalaria. El período de estudio es de 1995–1998. Se utilizó el test Mantel-Haenszel para analizar las tendencias del uso de 1a CCM. Se realizó un análisis de regresión para evaluar el efecto de período ajustado por paciente, características del hospital y área de residencia en la utilización de la CCM, así como un análisis multinivel para considerar las posibles, asociaciones entre las variables individuales y las variables agregadas.
La CCM se llevó a cabo en un 43% de mujeres en el período 1995–1998 y se observó un incremento significativo en su utilización. El análisis multinivel mostró que la edad y el volumen de actividad del hospital eran predictores significativos en la utilización de la CCM y los hospitales con mayor actividad mostraban un mayor porcentaje de CCM con relación a la mastectomía. A pesar de la evidencia que demuestra la efectividad de la cirugía conservadora de mama todavía existen considerables variaciones en su utilización que pueden ser debidos, en parte, a la actitud del profesional. La aplicación de determinados cambios en la organización de la atención oncológica permitirán obtener unos mejores resultados.
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Peris Tuser, M., Espinas Piñol, J.A., Bustins Poblet, M. et al. Variations in use of breast-conserving surgery by patient, hospital characteristics, and region: a multilevel analysis. Rev Oncol 3, 137–141 (2001). https://doi.org/10.1007/BF02711439
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DOI: https://doi.org/10.1007/BF02711439