Can levels of comorbidity provide an explanation for significant differences in management of breast cancer in the elderly in two neighbouring hospitals?
Association of Breast Surgery ePoster Library. Morrow E. 05/15/17; 166320; P075
Ms. Elizabeth Morrow
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Abstract
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Introduction
Previously we compared the management of elderly breast cancer patients in two neighbouring, city hospitals. We found Unit 1 to operate on a significantly higher proportion of patients compared to Unit 2. There was no difference in age, tumour pathology or deprivation scores. We evaluated levels of comorbidity as a possible explanation.
Methods
Breast cancer patients, aged over 70 years, treated at two hospitals between 2009-2013, were identified from a prospectively collected database. Charlson Comorbidity Index was calculated from comorbidity data collected from the electronic clinical record. Number of emergency hospital admissions in one year, and number of hospital bed days in two years preceding diagnosis, were obtained from National Services Scotland databases and compared using Chi square test.
Results
487 elderly breast cancer patients were treated in Unit 1 and 467 in Unit 2. Charlson score 6-9 was found in 15.4% patients treated with surgery at Unit 1, compared to 11.0% at Unit 2, and 0.8% surgical patients at Unit 1 had score of 10+ compared to 0% in Unit 2 (p=0.036). There was no significant difference between the median number of hospital days (range 0-232 Unit 1, 0-327 Unit 2; p=0.316) or emergency admissions (range 0-6 Unit 1; 0-7 Unit 2; p=0.679) between the units.
Conclusions
The difference in Charlson scores suggest that Unit 1 operated on patients with higher levels of comorbidity than Unit 2. Work is ongoing to ascertain multidisciplinary team members' attitudes and preferences, to explain the difference in management in two neighbouring units.
Previously we compared the management of elderly breast cancer patients in two neighbouring, city hospitals. We found Unit 1 to operate on a significantly higher proportion of patients compared to Unit 2. There was no difference in age, tumour pathology or deprivation scores. We evaluated levels of comorbidity as a possible explanation.
Methods
Breast cancer patients, aged over 70 years, treated at two hospitals between 2009-2013, were identified from a prospectively collected database. Charlson Comorbidity Index was calculated from comorbidity data collected from the electronic clinical record. Number of emergency hospital admissions in one year, and number of hospital bed days in two years preceding diagnosis, were obtained from National Services Scotland databases and compared using Chi square test.
Results
487 elderly breast cancer patients were treated in Unit 1 and 467 in Unit 2. Charlson score 6-9 was found in 15.4% patients treated with surgery at Unit 1, compared to 11.0% at Unit 2, and 0.8% surgical patients at Unit 1 had score of 10+ compared to 0% in Unit 2 (p=0.036). There was no significant difference between the median number of hospital days (range 0-232 Unit 1, 0-327 Unit 2; p=0.316) or emergency admissions (range 0-6 Unit 1; 0-7 Unit 2; p=0.679) between the units.
Conclusions
The difference in Charlson scores suggest that Unit 1 operated on patients with higher levels of comorbidity than Unit 2. Work is ongoing to ascertain multidisciplinary team members' attitudes and preferences, to explain the difference in management in two neighbouring units.
Introduction
Previously we compared the management of elderly breast cancer patients in two neighbouring, city hospitals. We found Unit 1 to operate on a significantly higher proportion of patients compared to Unit 2. There was no difference in age, tumour pathology or deprivation scores. We evaluated levels of comorbidity as a possible explanation.
Methods
Breast cancer patients, aged over 70 years, treated at two hospitals between 2009-2013, were identified from a prospectively collected database. Charlson Comorbidity Index was calculated from comorbidity data collected from the electronic clinical record. Number of emergency hospital admissions in one year, and number of hospital bed days in two years preceding diagnosis, were obtained from National Services Scotland databases and compared using Chi square test.
Results
487 elderly breast cancer patients were treated in Unit 1 and 467 in Unit 2. Charlson score 6-9 was found in 15.4% patients treated with surgery at Unit 1, compared to 11.0% at Unit 2, and 0.8% surgical patients at Unit 1 had score of 10+ compared to 0% in Unit 2 (p=0.036). There was no significant difference between the median number of hospital days (range 0-232 Unit 1, 0-327 Unit 2; p=0.316) or emergency admissions (range 0-6 Unit 1; 0-7 Unit 2; p=0.679) between the units.
Conclusions
The difference in Charlson scores suggest that Unit 1 operated on patients with higher levels of comorbidity than Unit 2. Work is ongoing to ascertain multidisciplinary team members' attitudes and preferences, to explain the difference in management in two neighbouring units.
Previously we compared the management of elderly breast cancer patients in two neighbouring, city hospitals. We found Unit 1 to operate on a significantly higher proportion of patients compared to Unit 2. There was no difference in age, tumour pathology or deprivation scores. We evaluated levels of comorbidity as a possible explanation.
Methods
Breast cancer patients, aged over 70 years, treated at two hospitals between 2009-2013, were identified from a prospectively collected database. Charlson Comorbidity Index was calculated from comorbidity data collected from the electronic clinical record. Number of emergency hospital admissions in one year, and number of hospital bed days in two years preceding diagnosis, were obtained from National Services Scotland databases and compared using Chi square test.
Results
487 elderly breast cancer patients were treated in Unit 1 and 467 in Unit 2. Charlson score 6-9 was found in 15.4% patients treated with surgery at Unit 1, compared to 11.0% at Unit 2, and 0.8% surgical patients at Unit 1 had score of 10+ compared to 0% in Unit 2 (p=0.036). There was no significant difference between the median number of hospital days (range 0-232 Unit 1, 0-327 Unit 2; p=0.316) or emergency admissions (range 0-6 Unit 1; 0-7 Unit 2; p=0.679) between the units.
Conclusions
The difference in Charlson scores suggest that Unit 1 operated on patients with higher levels of comorbidity than Unit 2. Work is ongoing to ascertain multidisciplinary team members' attitudes and preferences, to explain the difference in management in two neighbouring units.
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