You have accessJournal of UrologyPediatrics: Urinary Tract Infection/Vesicoureteral Reflux1 Apr 2013654 PHYSICIAN PREFERENCE IS A MAJOR FACTOR IN MANAGEMENT OF VESICOURETERAL REFLUX: A POPULATION-BASED ANALYSIS Olivia Lee, Blythe Durbin-Johnson, and Eric Kurzrock Olivia LeeOlivia Lee Sacramento, CA More articles by this author , Blythe Durbin-JohnsonBlythe Durbin-Johnson Davis, CA More articles by this author , and Eric KurzrockEric Kurzrock Sacramento, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.207AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Standard management of primary vesicoureteral reflux (VUR) includes observation, antibiotics, subureteric Deflux® or reimplantation. Factors affecting the management choice include reflux grade, frequency and severity of urinary tract infection, age and gender. We hypothesized that provider preference would be highly associated with management. METHODS The FPSC hospital consortium database was used to identify a population of pediatric urologists who saw VUR consultations in 2009. Practice patterns were determined using four metrics. A physician's reimplant utilization (RU) and Deflux® utilization (DU) percentage were calculated by dividing the number of each procedure by the number of new VUR patients in 2009, multiplied by 100. The sum (RU + DU) comprises the total surgical utilization percentage. Within each surgeon's cohort of surgical patients, we identified his/her Deflux® propensity (DP) and reimplant propensity (RP). A mixed effects logistic regression model was applied to the surgeon metrics, patient age, gender, insurance type and race to predict surgical treatment and type for a new VUR patient (significance defined as p<0.05). Importance rank was calculated for each variable. RESULTS We identified 67 pediatric urologists who saw 2,597 new VUR patients from 2009-2011. For every 100 new reflux patients, surgeon median utilization of reimplant and Deflux® were 23% and 15%, respectively. Thus, 38% of new patients were treated surgically within the 3-year period. Age was ranked highest in predicting surgical vs. non-surgical treatment. Among those who undergo surgery, variable importance rank found a surgeon's DP to be the highest predictor of surgery type. The median RP and DP were 61% and 39%, respectively. Increased age, female gender and white race increased the odds of Deflux® over reimplant. There was wide variation in surgical utilization between surgeons but minimal change for each individual surgeon over the 3-year period. CONCLUSIONS As expected, age was independently associated with reflux treatment. Surprisingly, gender and race were independently associated with surgery type. A surgeon's historical Deflux® propensity is the most important predictor of surgery type. Although data on reflux grade was not available, these results combined with the finding that the majority of surgeons had minimal change in their Deflux® propensity suggest that surgeon preference is the first or second most critical factor in determining a patient's treatment. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e267-e268 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Olivia Lee Sacramento, CA More articles by this author Blythe Durbin-Johnson Davis, CA More articles by this author Eric Kurzrock Sacramento, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...