High Surgeon Variation with Radical Prostatectomy

Considerable practice variation exists among surgeons at a high-volume academic center when selecting patients with prostate cancer to undergo radical prostatectomy, according to a study published in The Journal of Urology.

Hiten D. Patel, M.D., M.P.H., from Johns Hopkins Medical Institutions in Baltimore, and colleagues examined practice variability among urologists practicing at a high-volume academic center. The authors examined the percent of patients at low risk treated with radical prostatectomy in a given year and assessed the proportion of variance due to surgeon and temporal effects.

The researchers found that the percent of low-risk patients treated with prostatectomy increased 3.49 percent per year from 1991 to 2001 and decreased by 1.73 percent annually from 2001 to 2013.

From 1991 to 2001, in a given year, greater surgeon experience correlated with a higher percent of patients at low risk treated with prostatectomy (0.46 percent per year of experience). High-volume surgeons operated on a greater percent of low-risk patients (3.54 percent).

In a given year, surgeon level and temporal effects accounted for 24 and 70 percent, respectively, of the variance in the percent of patients at low risk treated with radical prostatectomy.

“In addition to patient decision support tools, publicly reporting individual practice patterns at the provider level could decrease the overtreatment of low-risk prostate cancer,” the authors write.

Reference

1. Patel, Hiten D., et al. “Practice Patterns and Individual Variability of Surgeons Performing Radical Prostatectomy at a High Volume Academic Center.” The Journal of Urology. DOI: http://dx.doi.org/10.1016/j.juro.2014.08.101. September 5, 2014.