Table 4.
Summary of the evidence for examined significant predictors, on multivariable analysis, of surgery utilisation and associated costs
| Predictor variables | Surgery | |||||||
|---|---|---|---|---|---|---|---|---|
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| Curative-intent surgery (25 studies, with 31 analyses$) [19,20,23,24,26,29,35,37,43,44,48-62] | Non-curative intent surgery (2 studies) [41,63] | Pre-operative biliary drainage (1 study) [87] | Hospitalisation costs following surgery (2 studies) [64,65] | |||||
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| No. of analyses* | Direction | No. of studies* | Direction | No. of studies* | Direction | No. of studies* | Direction | |
| Patient demographic characteristics | ||||||||
| Age | 25/26 | ↓Older (ref: younger) | 0/1 | n/a | 0/1 | n/a | 0/2 | n/a |
| Sex | 5/24 | Variable | 0/1 | n/a | 0/1 | n/a | 1/2 | ↓F (ref: M) |
| 4/5 ↑F (ref: M) | ||||||||
| 1/5 ↓F (ref: M) | ||||||||
| Race/ethnicity | 17/21 | ↓minority race (ref: Caucasian) | 0/1 | n/a | 0/1 | n/a | 1/2 | ↑Non-Hispanic/other (ref: Caucasian) |
| Preferred language | 0/1 | n/a | ||||||
| Education | 6/9 | Variable | 0/1 | n/a | ||||
| 5/6↓ lower education (ref: higher education) | ||||||||
| 1/6↑ lower education (ref: higher education) | ||||||||
| Income | 9/13 | ↓lower income (ref: higher income) | 0/1 | n/a | ||||
| Insurance | 10/12 | Variable& | 0/1 | n/a | ||||
| SES | 3/4 | ↓low SES (ref: high SES) | 0/1 | n/a | 0/1 | n/a | ||
| Location of residence | 2/9 | 1/2: ↓Unknown (ref: metro) | 0/1 | n/a | ||||
| 1/2: ↑Unknown (ref: metro) | ||||||||
| Marital status | 5/5 | ↑Married (ref: unmarried) | 0/1 | n/a | 0/1 | n/a | ||
| Disease characteristics | ||||||||
| TNM/ACJJ stage | 11/12 | Variable | 0/1 | n/a | 0/1 | n/a | ||
| 1/11: ↑stage II (ref: stage I) | ||||||||
| 2/11: ↓stage II (ref: stage I) | ||||||||
| 8/11: ↓stage III-IV (ref: stage I-II) | ||||||||
| Tumour site | 16/18 | Variable& | 2/2 | Variable | ||||
| ↓body/tail (ref: head) | ||||||||
| ↓other (ref: head) | ||||||||
| Tumour size | 4/5 | ↓increasing tumour size (ref: lowest tumour size) | 1/1 | ↓per 10 mm increase (ref: lowest tumour size) | ||||
| Grade/differentiation | 4/4 | Variable | 1/1 | ↓unknown (ref: low) | 0/1 | n/a | 0/1 | n/a |
| ↓high or unknown (ref: low) | ||||||||
| ↑Poor/ungraded (ref: well/moderately diff.) | ||||||||
| Nodal status | 1/1 | ↓Clinical N0 or Unknown (ref: pathologic N0) | 0/1 | n/a | ||||
| Metastasis | 1/1 | ↓metastatic (ref: non-metastatic) | ||||||
| T stage | 3/3 | ↑lower T stage (ref: higher T stage) | 0/1 | n/a | ||||
| N stage | 1/1 | ↑N1, ↓Nx (ref: N0) | 0/1 | n/a | ||||
| CCI/Charlson-Deyo Score | 7/10 | Variable | 1/2 | ↑increasing CCI (ref: CCI: 0) | 1/1 | ↑CCI≥3 | ||
| 5/7: ↓increasing CCI (ref: CCI: 0) | ||||||||
| 2/7: ↑increasing CCI or CCI of 1 (ref: CCI: 0) | ||||||||
| Elixhauser comorbidity index | 1/1 | ↑increasing score (ref: lowest score) | ||||||
| Performance status | 1/1 | ↓Not fully active (ref: fully active) | ||||||
| Treatment characteristics | ||||||||
| Year of diagnosis/treatment | 10/16 | 8/10: ↑per year increase (ref: lowest year) | 0/1 | n/a | 1/1 | ↑per year increase (ref: lowest year) | ||
| 2/10: ↓per year increase (ref: lowest year) | ||||||||
| MDT presentation | 1/1 | ↓Presented at MDT (ref: not presented) | ||||||
| Pancreas protocol CT | 0/1 | n/a | ||||||
| CT | 0/1 | n/a | ||||||
| EUS | 1/1 | ↑Yes (ref: no) | ||||||
| Laparoscopy | 0/1 | n/a | ||||||
| MRI/Cholangiopancreatography | 0/1 | n/a | ||||||
| Gastroenterologist | 1/1 | ↓Yes (ref: no) | 1/1 | ↑Yes (ref: no) | ||||
| Chemotherapy | 1/1 | ↑Yes, ↓refused (ref: no) | 1/1 | ↑neoadjuvant chemotherapy (ref: no neoadjuvant chemotherapy) | 1/1 | ↓Adjuvant chemotherapy (Ref: none) | ||
| Surgery type | 2/2 | ↓Distal pancreatectomy (ref: pancreaticoduodenectomy) | ||||||
| Length of Stay | 1/1 | ↑Yes (ref: no) | ||||||
| Post-operative complications | 2/2 | ↑Yes (ref: no) | ||||||
| Readmission following operation | 1/1 | ↑Yes (ref: no) | ||||||
| Health service characteristics | ||||||||
| Hospital type | 4/5 | Variable | 0/1 | n/a | 1/2 | ↑Teaching hospital (ref: non-teaching hospital) | ||
| 3/4 ↓Community or comprehensive (ref: academic) | ||||||||
| 1/4 ↑Comprehensive/academic/integrated network (ref: community) | ||||||||
| Hospital volume (i.e. no. of procedures per year) | 1/2 | ↑≥ pancreatectomies per year (ref: <5 pancreatectomies per year) | 1/1 | ↑decreasing volume (ref: very high volume) | 1/2 | ↓intermediate (ref: low) | ||
Number of analyses/studies = Studies with significant findings in relation to the predictor variable (numerator)/total number of studies evaluating the predictor variable (denominator).
1 study (Huang et al. 2019) conducted 7 separate analyses of data from different populations. These have been counted separately.
Variable groupings/reference categories have been used by different studies to categorise, therefore it is not possible to comment on overall direction.
Abbreviations: AJCC, American Joint Committee on Cancer; CCI, Charlson Comorbidity Index; CT, computed tomography; EUS, endoscopic ultrasound; MDT, Multidisciplinary team meeting; SES, Socioeconomic status; TNM, Tumour, Node, Metastasis staging system.