De-implementation of Axillary Dissection in Women With Breast Cancer is Largely Driven By Site-level Contextual Effects

*Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, Colorado

†Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado

‡Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado

§Department of Surgery, Washington University School of Medicine, St. Louis, Missouri

||Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York

¶Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado

#Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado

[email protected].

Authors Contribution: Ana L. Gleisner, MD, PhD - made substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Angela Moss, MS – made substantial contributions to conception and design, and analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Chloe Friedman, MPH – made substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Krithika Suresh, PhD – made substantial contributions to conception and design, and analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Gary Grunwald, PhD – made substantial contributions to conception and design, and analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Robert J. Torphy, MD – made substantial contributions to conception and design, and analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Laura D. Leonard, MD – made substantial contributions to conception and design, and analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Kathryn Colborn, PhD – made substantial contributions to analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Gretchen Ahrendt, MD – made substantial contributions to analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Sarah Tevis, MD – made substantial contributions to analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Nicole Christian, MD – made substantial contributions to analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Viviane L. Abud, MD – made substantial contributions to conception and design, and analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Thiago B. de Araujo, MD – made substantial contributions to analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Laurel E. Beaty, BS – made substantial contributions to analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Daniel Thieu, MD – made substantial contributions to conception and design, and analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Thomas J. Glorioso – made substantial contributions to analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Simon Kim, MD – made substantial contributions to conception and design, and analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

Stacie Daugherty, MD – made substantial contributions to conception and design, and analysis and interpretation of data. Participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.

The National Cancer Database (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC’s NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.annalsofsurgery.com).

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