73 RACIAL VARIATION IN THE UTILIZATION OF HIGH-VOLUME SURGEONS AND HOSPITALS FOR RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 201173 RACIAL VARIATION IN THE UTILIZATION OF HIGH-VOLUME SURGEONS AND HOSPITALS FOR RADICAL PROSTATECTOMY Daniel Barocas, Darryl Gray, Jay Fowke, Stephen Kappa, Jeffrey Blume, Nathaniel Mercaldo, Sam Chang, Michael Cookson, Joseph A. Smith, and David Penson Daniel BarocasDaniel Barocas Nashville, TN More articles by this author , Darryl GrayDarryl Gray Rockville, MD More articles by this author , Jay FowkeJay Fowke Nashville, TN More articles by this author , Stephen KappaStephen Kappa Nashville, TN More articles by this author , Jeffrey BlumeJeffrey Blume Nashville, TN More articles by this author , Nathaniel MercaldoNathaniel Mercaldo Nashville, TN More articles by this author , Sam ChangSam Chang Nashville, TN More articles by this author , Michael CooksonMichael Cookson Nashville, TN More articles by this author , Joseph A. SmithJoseph A. Smith Nashville, TN More articles by this author , and David PensonDavid Penson Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.137AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Differences in quality of care may contribute to racial variation in outcomes of men with prostate cancer. Quality indicators in men undergoing radical prostatectomy (RP) include surgeon and hospital volume. We compared African-American (AA) and Caucasian men's use of high-volume surgeons (HVSs) and high-volume hospitals (HVHs) for RP and determined whether differential use of HVSs and HVHs were associated with differences in short-term outcomes (in-hospital mortality and length of stay [LOS]). METHODS We used public-access versions of the Healthcare Cost and Utilization Project's State Inpatient Databases, selecting NY, FL, and MD (1996–2007), because they consistently included race and surgeon identifiers. Cases were identified by ICD-9-CM codes. Surgeon and hospital volume were defined as the number of RPs performed within a calendar year, with quartiles defined by state and year. Use of HVSs and HVHs (highest quartile) was compared across racial groups using logistic regression, adjusting for age, insurance, state and year of surgery. We performed logistic regression for in-hospital mortality, adjusting for age, LOS and comorbidity score; we then added terms for use of HVH and HVS to determine whether the effect of race on in-hospital mortality was attenuated by procedure volume. We did a similar linear regression for LOS, controlling for age, payer, comorbidity and state, with and without terms for use of HVSs and HVHs. RESULTS There were 106,000 RPs; 76.5% White, 13.2% AA, 10.2% Other. Fewer AA than White men utilized HVSs (59.1% vs. 70.0%, p<0.001) and HVHs (66.1% vs. 74.3%, p<0.001). Compared to Whites, AA men had lower adjusted odds of utilizing HVSs (0.81, 95% CI [0.77, 0.85], p<0.001) and HVHs (0.65, [0.62, 0.67], p<0.001). AA men had higher in-hospital mortality than Whites (0.16% vs. 0.07%, p=0.004), but the effect was attenuated with adjustment for HVH, HVS and other factors (OR 1.55 [0.91, 2.65], p=0.11). Similarly, AA race was associated with longer LOS on univariate analysis (Coefficient 0.50 [0.46, 0.54], p<0.001) and the effect was attenuated in multivariate analysis including use of HVH and HVS (Coefficient 0.36 [0.32, 0.40], p<0.001). CONCLUSIONS As indicators of healthcare quality, utilization of HVSs and HVHs for RP vary by race. The effect of race on in-hospital mortality and LOS is attenuated to an extent by differential use of HVSs and HVHs, among other factors. These findings may identify a quality gap and some of its consequences. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e31-e32 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Barocas Nashville, TN More articles by this author Darryl Gray Rockville, MD More articles by this author Jay Fowke Nashville, TN More articles by this author Stephen Kappa Nashville, TN More articles by this author Jeffrey Blume Nashville, TN More articles by this author Nathaniel Mercaldo Nashville, TN More articles by this author Sam Chang Nashville, TN More articles by this author Michael Cookson Nashville, TN More articles by this author Joseph A. Smith Nashville, TN More articles by this author David Penson Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...