MP11-13 PREDICTORS FOR THE USE OF INTRAVESICAL MITOMYCIN-C FOLLOWING TRANSURETHRAL RESECTION OF BLADDER TUMORS IN THE UNITED STATES: A POPULATION BASED ANALYSIS

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2014MP11-13 PREDICTORS FOR THE USE OF INTRAVESICAL MITOMYCIN-C FOLLOWING TRANSURETHRAL RESECTION OF BLADDER TUMORS IN THE UNITED STATES: A POPULATION BASED ANALYSIS Nedim Ruhotina, Jeffrey Leow, Wei Jiang, Benjamin L. Chung, Jonathan Rosenberg, Adam Kibel, Quoc Dien Trinh, and Steven L. Chang Nedim RuhotinaNedim Ruhotina More articles by this author , Jeffrey LeowJeffrey Leow More articles by this author , Wei JiangWei Jiang More articles by this author , Benjamin L. ChungBenjamin L. Chung More articles by this author , Jonathan RosenbergJonathan Rosenberg More articles by this author , Adam KibelAdam Kibel More articles by this author , Quoc Dien TrinhQuoc Dien Trinh More articles by this author , and Steven L. ChangSteven L. Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.428AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiple phase III trials have demonstrated that a single intravesical instillation of mitomycin C (MMC) within 24 hours after transurethral resection of non-muscle-invasive bladder tumor reduces the risk of locally recurrent disease. We analyzed a contemporary population-based cohort to determine the prevalence and predictors of immediate post operative administration of MMC (IPOMC) in the United States. METHODS We analyzed patient-level data from a proprietary national inpatient discharge database, which collects data from over 400 non-federal hospitals throughout the United States. We captured all men who underwent a transurethral resection of bladder tumor (TURBT) or cystoscopy with bladder biopsy between January 1, 2003, and December 31, 2010, based on the International Classification of Disease, 9th edition, codes 57.49 and 57.33 respectively. We identified the use of intravesical MMC within 24 hours of endoscopic therapy through a detailed review of the hospital charge data. The data were analyzed with descriptive statistics and logistic regression models. RESULTS Overall, the rate of IPOMC utilization increased from 4.0% in 2003 to 10.0% in 2010. While in providers who administered IPOMC at least once, the rate of IPOMC use increased from 14.6% in 2003 to 25.4% in 2010. There was a higher likelihood of IPOMC use in patients who were older than age 75 compared to patients less than age 55 (OR 1.73, p=0.03). Patients who had a Charlson co-morbidity index (CCI) of 1 were less likely to receive IPOMC compared to patients with CCI of 0 (OR 0.81, p=0.01). In subgroup analysis of providers who administered at least one dose of IPOMC, the highest annual volume providers were less likely to administer IPOMC (OR 0.54, p=0.01) than lower volume providers. Compared to lowest volume hospitals, in the highest volume hospitals there was a lower likelihood of IPOMC administration (OR 0.6, p=0.04). Patient gender, race, insurance status, hospital location, size and teaching affiliation did not affect IPOMC administration. CONCLUSIONS Despite the abundance of data supporting the use of intravesical MMC within 24 hours after endoscopic management of bladder tumors, adoption of this practice in the United States is severely limited. Our findings are particularly concerning as young patients who would most likely benefit from IPOMC are the ones least likely to receive the therapy. Barriers to more widespread use may include surgeon experience and biases and institutional restrictions. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e100-e101 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Nedim Ruhotina More articles by this author Jeffrey Leow More articles by this author Wei Jiang More articles by this author Benjamin L. Chung More articles by this author Jonathan Rosenberg More articles by this author Adam Kibel More articles by this author Quoc Dien Trinh More articles by this author Steven L. Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...