MP49-01 IMPACT OF DIAGNOSING UROLOGISTS AND HOSPITALS ON USE OF RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive I (MP49)1 Apr 2020MP49-01 IMPACT OF DIAGNOSING UROLOGISTS AND HOSPITALS ON USE OF RADICAL CYSTECTOMY Vishnukamal Golla, Yong Shan, Hemalkumar Mehta, Zachary Klaassen, Douglas Tyler, Jacques Baillaregon, Ashish Kamat, Stephen Freedland, John Gore, Preston Kerr*, Karim Chamie, Yong-Fang Kuo, and Stephen Williams Vishnukamal GollaVishnukamal Golla More articles by this author , Yong ShanYong Shan More articles by this author , Hemalkumar MehtaHemalkumar Mehta More articles by this author , Zachary KlaassenZachary Klaassen More articles by this author , Douglas TylerDouglas Tyler More articles by this author , Jacques BaillaregonJacques Baillaregon More articles by this author , Ashish KamatAshish Kamat More articles by this author , Stephen FreedlandStephen Freedland More articles by this author , John GoreJohn Gore More articles by this author , Preston Kerr*Preston Kerr* More articles by this author , Karim ChamieKarim Chamie More articles by this author , Yong-Fang KuoYong-Fang Kuo More articles by this author , and Stephen WilliamsStephen Williams More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000911.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One out of five patients with muscle-invasive bladder cancer undergo radical cystectomy—a guideline-recommended treatment. Previous studies have primarily evaluated patient characteristics associated with use of radical cystectomy. Our goal was to determine the impact of patient, diagnosing urologist, and hospital characteristics on the variation in the use of radical cystectomy. METHODS: This was a retrospective cohort study using the Surveillance, Epidemiology, and End Results Registry (SEER)-Medicare linked database. Data analysis was performed from October 5, 2018 through March 8, 2019. Clinical stage T2–T4a bladder cancer from January 1, 2002 to December 31, 2011 were analyzed. Using the American Medical Association (AMA) Physician Masterfile, we identified diagnosing urologists affiliated with hospitals. Multilevel logistic regression analyses were used to determine variation and factors associated with use of radical cystectomy. RESULTS: A total of 7,097 patients diagnosed with clinical stage T2–T4a bladder cancer from January 1, 2002 to December 31, 2011 were analyzed. Using the American Medical Association (AMA) Physician Masterfile, we identified 4,601 diagnosing urologists affiliated with 822 hospitals. Of the 7,097 patients, only 27% underwent radical cystectomy. After adjusting for case-mix differences, there was wide variation in use of radical cystectomy among hospitals (10–37%). The intraclass correlation coefficient (ICC) for variation in use of radical cystectomy attributed to the hospital level was 4.3%. Higher radical cystectomy volume by diagnosing urologists (5+ vs. 0–1 surgeries: odds ratio [OR], 1.27; 95% confidence interval [CI], 1.00–1.62) and hospitals (5+ vs. 0–4 surgeries: OR,1.48; 95% CI, 1.14–1.93) was associated with increased use of radical cystectomy. Patients diagnosed by female rather than male urologists were more likely to undergo radical cystectomy (OR, 1.32; 95% CI, 1.07–1.62). CONCLUSIONS: We found a 4.3% variation in the use of radical cystectomy that was attributed to the hospital level leaving 95.7% variation in use unexplained. We identified significantly increased use among higher volume and female diagnosing urologists. These findings support further investigation into measures beyond hospital volume that largely impact radical cystectomy utilization. Source of Funding: This study was funded by the Kahlert Foundation and the American Urological Association (AUA) Residency Research Award. This study was conducted with the support of a Department of Defense Peer Reviewed Cancer Research Program (PRCRP) Career Development Award (W81XWH1710576) (SBW). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e739-e739 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vishnukamal Golla More articles by this author Yong Shan More articles by this author Hemalkumar Mehta More articles by this author Zachary Klaassen More articles by this author Douglas Tyler More articles by this author Jacques Baillaregon More articles by this author Ashish Kamat More articles by this author Stephen Freedland More articles by this author John Gore More articles by this author Preston Kerr* More articles by this author Karim Chamie More articles by this author Yong-Fang Kuo More articles by this author Stephen Williams More articles by this author Expand All Advertisement PDF downloadLoading ...