489 USE OF PARTIAL NEPHRECTOMY IN RURAL VERSUS URBAN PRACTICE SETTINGS

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2010489 USE OF PARTIAL NEPHRECTOMY IN RURAL VERSUS URBAN PRACTICE SETTINGS Christopher Filson, Zaojun Ye, and David Miller Christopher FilsonChristopher Filson More articles by this author , Zaojun YeZaojun Ye More articles by this author , and David MillerDavid Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.564AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) is underutilized for patients with early-stage renal cell carcinoma (RCC). For a variety of reasons, urologists working in rural settings may be particularly slow to adopt nephron-sparing surgery (NSS), potentially exacerbating unwarranted variations in the use of PN. In this context, we evaluated differences in the longitudinal utilization of PN among patients with RCC treated by surgeons working in rural versus urban practice settings. METHODS Using linked SEER-Medicare data, we identified patients who underwent surgical treatment for RCC from 1995 through 2005. We used a validated algorithm to determine whether each patient received NSS (i.e., partial nephrectomy) or radical nephrectomy. We used rural-urban commuting area codes (based on the zip code of the surgeon's primary office) to classify each surgeon's practice setting as rural (population < 10,000), micropolitan (population 10,000-50,000), or urban (population > 50,000). We then used bivariate and multivariate analyses to evaluate the relationship between surgeon practice setting and patient receipt of PN, adjusting for both tumor size and year of diagnosis. RESULTS We identified 12,899 patients treated surgically for RCC by 2,057 unique surgeons. Among the surgeons, 37 (1.8%) and 141 (6.8%) worked in rural and micropolitan practice settings, respectively. During the study interval, the proportion of patients treated with NSS by urban surgeons increased from 8.7% (1995) to 21.6% (2005), compared with an increase from 4.4% to 17.8% among patients treated by surgeons in non-urban settings (p<0.01) (Figure). After adjusting for tumor size and year of diagnosis, patients treated by rural (OR=0.32, 95% CI 0.12-0.87) and micropolitan (OR=0.62, 95% CI 0.43-0.89) surgeons remained significantly less likely than those treated by urban surgeons to receive NSS. CONCLUSIONS Patients with RCC who receive treatment from surgeons in non-urban settings are significantly less likely to undergo NSS. These data highlight the need for educational and other initiatives aimed at dismantling barriers to the adoption of NSS among urologists in more geographically-isolated practice settings. Ann Arbor, MI© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e193 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Filson More articles by this author Zaojun Ye More articles by this author David Miller More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...