PD18-05 CHARACTERISTICS OF CERTIFYING UROLOGISTS PERFORMING CYSTECTOMIES IN THE UNITED STATES

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You have accessJournal of UrologyBladder Cancer: Invasive I1 Apr 2014PD18-05 CHARACTERISTICS OF CERTIFYING UROLOGISTS PERFORMING CYSTECTOMIES IN THE UNITED STATES Andrew Flum, Daniel Oberlin, Laurie Bachrach, Sarah Flury, and Joshua Meeks Andrew FlumAndrew Flum More articles by this author , Daniel OberlinDaniel Oberlin More articles by this author , Laurie BachrachLaurie Bachrach More articles by this author , Sarah FlurySarah Flury More articles by this author , and Joshua MeeksJoshua Meeks More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1500AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives The skill and training of the surgeon performing radical cystectomy can have a significant impact on bladder cancer outcomes as survival is directly related to surgical factors including margin status and extent of lymph node dissection. Repeated studies demonstrate an association with improved 30-day mortality and overall survival when performed by high volume surgeons at experienced centers. We aim to characterize the training and surgical volume of urologists that perform radical cystectomy for bladder cancer in the US. Methods Six month case log data of urologists certifying between 2003 and 2013 was obtained from the American Board of Urology (ABU). Cases specifying both an ICD-9 code for bladder cancer and a CPT code for radical cystectomy were analyzed for surgeon specific variables. Results A total of 5,335 cystectomies in the case log system were performed by 2,102 urologists with 289 (5.4%) performed laparoscopically or robotically. Median urologist age was 43 (range 37-51) years. The median number of cystectomies performed was 2 (interquartile range 1-3) with the top 10% of urologists performing 5 or more cystectomies (Figure). Half of cystectomies (50%) were performed by a urologist who performed only one during the certification period. Urologists initially certified after the year 2000 performed the majority (57%) of cystectomies and 40% were logged by urologists certifying for the first time. The most common specialty of urologists was general urology (45%), while 24% were performed by oncologists. The most common practice type was private practice (45%) compared to non-private practice (38%) and mixed private and non-private practice (17%). For minimally invasive cystectomy, 10% of logged cases were performed by a single surgeon and 54% of surgeons logged only a single minimally invasive cystectomy. Using multivariate logistic regression, predictors of performing a minimally invasive cystectomy were academic institution (OR 1.4 [95% CI 1.1-1.80], p=0.01), and certification between 2012 and 2013 (OR 4.6 [95% CI 3.4-6.1], p<0.0001). Conclusions Despite the higher complexity associated with the surgical management of bladder cancer with radical cystectomy, the majority of cystectomies are performed by low-volume surgeons that have most often applied for their first certification with the ABU. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e536-e537 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Andrew Flum More articles by this author Daniel Oberlin More articles by this author Laurie Bachrach More articles by this author Sarah Flury More articles by this author Joshua Meeks More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...