334 FACTORS ASSOCIATED WITH THE ADOPTION OF MINIMALLY-INVASIVE RADICAL PROSTATECTOMY IN THE UNITED STATES

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology and Natural History II1 Apr 2012334 FACTORS ASSOCIATED WITH THE ADOPTION OF MINIMALLY-INVASIVE RADICAL PROSTATECTOMY IN THE UNITED STATES William Ulmer, Sandip Prasad, Keith Kowalczyk, Xiangmei Gu, Christopher Dodgion, Stuart Lipsitz, and Jim Hu William UlmerWilliam Ulmer Boston, MA More articles by this author , Sandip PrasadSandip Prasad Chicago, IL More articles by this author , Keith KowalczykKeith Kowalczyk Washington DC, DC More articles by this author , Xiangmei GuXiangmei Gu Boston, MA More articles by this author , Christopher DodgionChristopher Dodgion Boston, MA More articles by this author , Stuart LipsitzStuart Lipsitz Boston, MA More articles by this author , and Jim HuJim Hu Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.395AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Minimally invasive radical prostatectomy (MIRP) has supplanted retropubic radical prostatectomy (RRP) in popularity despite the absence of comparative effectiveness data demonstrating superiority. We examined the influence of patient, surgeon, and hospital characteristics on the utilization of MIRP vs. RRP. METHODS Using Surveillance, Epidemiology and End Results-Medicare linked data, we identified 6,880 men diagnosed with prostate cancer from 2002-2005 who subsequently underwent radical prostatectomy. We assessed the relative contribution of patient, surgeon and hospital characteristics on the likelihood of undergoing MIRP vs. RRP using multi-level logistic regression mixed models. RESULTS Hospital factors (28.5%) contributed most to the use of MIRP vs. RRP, followed by patient (25.3%) and surgeon (12.5%) factors. Among patient-specific factors, Asian race (vs. white: odds ratio [OR] 1.86, 95% confidence interval [CI] 1.27–2.72; p=0.001), stage T1 tumors (vs. T3/T4: OR 2.71, 95% CI 1.60–4.57, p<0.001), and obtaining a second opinion (OR 3.41, 95% CI 2.67-4.37, p<0.001) were associated with increased MIRP utilization while lower median income was associated with decreased MIRP utilization. Among surgeon- and hospital-specific factors, increasing surgeon volume (OR 1.022, 95% CI 1.015-1.028, p<0.001), surgeon age less than 50 (OR 2.68, 95% CI 1.69–4.24, p<0.001), and hospital bed size (OR 1.001, 95% CI 1.001-1.002, p<0.001) were associated with increased MIRP utilization, while surgeons employed in a solo or two physician practice was associated with decreased MIRP utilization (OR 0.48, 95% CI 0.27–0.86, p=0.013). CONCLUSIONS The rapid adoption of MIRP vs. RRP is multi-factorial and associated with specific patient-, surgeon-, and hospital-related factors. Men receiving a second opinion are over three times more likely to undergo MIRP, which may reflect the influence of direct-to consumer advertising on utilization of MIRP. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e136 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information William Ulmer Boston, MA More articles by this author Sandip Prasad Chicago, IL More articles by this author Keith Kowalczyk Washington DC, DC More articles by this author Xiangmei Gu Boston, MA More articles by this author Christopher Dodgion Boston, MA More articles by this author Stuart Lipsitz Boston, MA More articles by this author Jim Hu Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...