Moderated Poster

Poster, Podium & Video Sessions

MP69-20: The Impact of State Laws Limiting Malpractice Awards on Diffusion of Surgical Innovation: The Case of Minimally Invasive Radical Prostatectomy

Monday, May 15
7:00 AM - 9:00 AM
Location: BCEC: Room 153

Presentation Authors: Shyam Sukumar*, Oluwakayode Adejoro, Badrinath Konety, Minneapolis, MN

Introduction: While previous studies have evaluated the impact of malpractice caps on health care utilization and physician density, their effect on the adoption of innovative technology is unknown. We examined whether such caps impacted the national diffusion of minimally invasive radical prostatectomy (MIRP) for prostate cancer (PCa). For comparison we also examined trends in the diffusion of two technologies that antedate MIRP and are in their post-dissemination era: laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN) for renal cell carcinoma (RCC).

Methods: We identified patients ≥66 years with non-metastatic PCa between 2003-2011 in the SEER-Medicare database. Our cohort (n=129,793) was classified based on the existence of a limit on non-economic damages in their geographical locations: states with a cap before and through our study period (cap states), states without cap before and through the study (non-cap states) and states whose cap was introduced during our study period (late-cap states). Multivariable logistic regression models were fitted to examine the influence of &[prime]cap&[prime] status on MIRP adoption while controlling for demographic and tumor characteristics. A similar analysis was performed for patients with non-metastatic RCC undergoing LRN and LPN.

Results: Median age (IQR) of our PCa cohort was 74 years (70-79 years). 84% were White; 97% had T1/ T2 disease and 52% had high-grade disease. 17% were treated with radical prostatectomy (RP): 8.1% with MIRP and 8% with open RP (0.9%-unknown). Adoption of MIRP was quicker in cap-states than in non-cap and late-cap states (p<0.0001, Figure 1). On multivariable analysis, there was a 70% higher likelihood of receipt of MIRP in patients in a cap-state compared to a non-cap state (OR: 1.7, P<0.0001). In contrast to MIRP, the diffusion of LPN and LRN were not different between cap and non-cap states on multivariable modeling (P≥0.05).

Conclusions: In a contemporary national cohort of PCa patients, states with malpractice caps had higher MIRP adoption rates. Diffusion rates of background technologies (LRN, LPN) in their post dissemination phase were not different in such states, highlighting the primacy of malpractice caps in explaining the differential effect on MIRP diffusion rates.

Source Of Funding: None

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