Variations in Preoperative Use of Bone Scan Among Medicare Beneficiaries Undergoing Radical Cystectomy

Abstract

To examine factors associated with bone scan use in patients undergoing radical cystectomy and to assess trends in use over time. Using Surveillance, Epidemiology, and End Results-Medicare data, we identified 5573 patients who underwent radical cystectomy from 2004 to 2011. The primary outcome was completion of a bone scan within 6 months prior to surgery. Demographic, regional, and clinicopathologic predictors of bone scan use were examined using a mixed logit model with health service area as a random effect. Among radical cystectomy patients, 1754 (31%) completed a preoperative bone scan. Urologists ordered most of these studies (69%). The adjusted probability of a patient undergoing a bone scan decreased from 0.40 in 2004 to 0.29 in 2011 (P = .01). Compared with patients in the northeast region, those in the south, central, and west regions were less likely to have a bone scan (P <.001). Compared with those with stage ≤T1, patients with higher stage disease were more likely to have a bone scan (P <.001). Among the highest volume surgeons, there was significant variation in the proportion of patients who completed preoperative bone scans (P < .001). Despite a recent decline, bone scans are used frequently in the preoperative staging of bladder cancer. Although some clinical factors are associated with bone scan use, significant regional and provider variation suggest areas to improve standardization of practice.