PHS61 - Follow-Up Imaging After Nephrectomy in Canada: Urologists’ Compliance with Guidelines and Cost of Surveillance

Abstract

Renal cell carcinoma is associated with a stage migration due to earlier diagnosis associated with availability of medical imaging. Surgical treatment remains the preferred treatment option for most patients. Many medical associations have proposed guidelines for the optimal follow up of patients post surgery. The goal of our study was to evaluate the adherence of Canadian urologists to the follow up guidelines proposed by the Canadian Urological Association (CUA) and its economic impact. The cohort studied was identified from the Canadian Kidney Cancer information system (CKCis). A total of 1655 patients from 15 academic institutions contributed to this prospectively collected patient population. Patients included in this cohort underwent radical or partial nephrectomy for a pT1-3N0M0 renal cancer after January 1st 2011. Follow up abdominal and thoracic imaging performed during the follow up period were captured and compared with the proposed follow up guidelines from the CUA. Of the 1655 patients, 1159, 141 and 355 were stage pT1, pT2 and pT3 respectively. A total of 1649 chest imaging and 2404 abdominal imaging were performed during the follow up period. Adherence to post operative surveillance guideline was found to be sub-optimal with ratio of expected v. observed of 74% and 222% for chest and abdominal imaging respectively. The highest disparity in chest imaging was observed in pT2 (52%) and in pT1 (440%) for abdominal imaging. It is estimated that the sub optimal adherence to follow up guidelines would generate an extra cost of close to $40 millions dollars over a period of 6 years in Canada. This study highlights the suboptimal adherence to follow up guidelines and its economic impact on Canadian health care system.