Surgical Quality Is More Than Volume: The Association between Changing Urologists and Complications for Patients with Localized Prostate Cancer
Article first published online: 24 JAN 2014
© Health Research and Educational Trust
Health Services Research
Volume 49, Issue 4, pages 1165–1183, August 2014
How to Cite
DuGoff, E. H., Bekelman, J. E., Stuart, E. A., Armstrong, K. and Pollack, C. E. (2014), Surgical Quality Is More Than Volume: The Association between Changing Urologists and Complications for Patients with Localized Prostate Cancer. Health Services Research, 49: 1165–1183. doi: 10.1111/1475-6773.12148
- Issue published online: 23 JUL 2014
- Article first published online: 24 JAN 2014
- National Cancer Institute
- Office of Behavioral and Social Sciences. Grant Number: K07 CA151910
- National Institute of Mental Health. Grant Number: K25 MH083846
- NCI. Grant Number: K07 CA163616
- Maryland Cigarette Restitution Fund Research
- Quality of care;
- physician switching;
- cancer care
To examine the association of changing urologists on surgical complications in men with prostate cancer.
Data Sources/Study Setting
Registry and administrative claims data from the Surveillance, Epidemiology, and End Results-Medicare database from 1995 to 2005.
A cross-sectional observational study of men with prostate cancer who underwent radical prostatectomy.
Subjects were classified as having “changed urologists” if they had a different urologist who diagnosed their cancer from the one who performed their surgery. “Doubly robust” propensity score weighted multivariable logistic regression models were used to investigate the effect of changing urologists on 30-day surgical complications, late urinary complications, and long-term incontinence.
Men who changed urologists between diagnosis and treatment had significantly lower odds of 30-day surgical complications compared with men who did not change urologists (odds ratio: 0.82; 95 percent confidence interval: 0.76–0.89), after adjustment. Changing urologists was associated with lower risks of 30-day complications for both black and white men compared with staying with the same urologist for their diagnosis and surgical treatment.
Urologist changing is associated with the observed variation in complications following radical prostatectomy. This may suggest that patients are responding to aspects of surgical quality not captured in surgical volume.