424 A POPULATION-BASED STUDY OF SURGEON CHARACTERISTICS ASSOCIATED WITH THE UPTAKE OF CONTEMPORARY TECHNIQUES IN RENAL SURGERY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness III1 Apr 2012424 A POPULATION-BASED STUDY OF SURGEON CHARACTERISTICS ASSOCIATED WITH THE UPTAKE OF CONTEMPORARY TECHNIQUES IN RENAL SURGERY Stanley Yap, Shabbir Alibhai, David Margel, Robert Abouassaly, Narhari Timilshina, and Antonio Finelli Stanley YapStanley Yap Toronto, Canada More articles by this author , Shabbir AlibhaiShabbir Alibhai Toronto, Canada More articles by this author , David MargelDavid Margel Toronto, Canada More articles by this author , Robert AbouassalyRobert Abouassaly Cleveland, OH More articles by this author , Narhari TimilshinaNarhari Timilshina Toronto, Canada More articles by this author , and Antonio FinelliAntonio Finelli Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.490AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current evidence supports new standards in the surgical management of renal tumors. Despite such evidence, we have witnessed a slow uptake of many of these contemporary techniques. Furthermore, we have a poor understanding of the factors involved in such uptake. We sought to evaluate surgeon-level characteristics associated with the uptake of laparoscopy, partial nephrectomy (PN), and adrenal-sparing approaches in the surgical management of renal tumors. METHODS Using the Ontario Cancer Registry, we identified surgeons treating renal cell carcinoma (RCC) in the province of Ontario, Canada between the years of 2002 to 2004. We then classified individuals within this cohort as either high or low utilizers of laparoscopy, PN, or adrenal-sparing approaches. Further variables analyzed included academic status, surgeon graduation year, and surgical volume status. We then utilized univariable and multivariable logistic regression models to assess predictors of uptake. RESULTS We evaluated 108 surgeons for their uptake of both laparoscopy and adrenal-sparing approaches and 94 surgeons for their uptake of PN. Regarding laparoscopy, we identified 32 surgeons (30%) as high users based on a cut-off of using laparoscopic approaches in at least 50% of their radical nephrectomies for tumors 7cm or smaller. Predictors of uptake of laparoscopy included graduation year after 1990 (OR 4.81, 95% CI 1.57-14.8) and high surgeon volume (OR 4.33, 1.60-10.4). We identified 41 surgeons (44%) as high users of PN based on a threshold of performing PN for >33% of their cases for T1a tumors. The only significant predictor of uptake of PN was academic status (OR 5.83, 1.96-17.3). We identified 69 surgeons (65%) as high users of adrenal-sparing approaches but did not identify any significant predictors for uptake in this group. CONCLUSIONS We identify unique factors contributing to the uptake of distinct surgical techniques in the management of RCC. This information sheds light on the underlying mechanisms and helps us understand how to further encourage the dissemination of these practices to achieve the highest quality of surgical care. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e174 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stanley Yap Toronto, Canada More articles by this author Shabbir Alibhai Toronto, Canada More articles by this author David Margel Toronto, Canada More articles by this author Robert Abouassaly Cleveland, OH More articles by this author Narhari Timilshina Toronto, Canada More articles by this author Antonio Finelli Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...