Oncology - Prostate
Introduction & Objective :
Volumes of radical prostatectomy (RP) have decreased in recent years for a variety of reasons, including greater use of expectant management and decreased screening and diagnosis. It is not clear, however, how changes in surgical practice have varied across healthcare regions. In this study, we 1) investigated regional variation in changes in RP volume, and 2) hypothesized that high initial volume was associated with a greater decrease over time, assuming that high volume may represent overtreatment of older patients.
Using publicly available longitudinal research files (http://www.dartmouthdiffusion.org/index.php#) from The Dartmouth Atlas, we examined annual incidence of RP across hospital referral regions (HRRs) between 2004-2014 in a Medicare population. RP rates were adjusted for age and race, and procedure codes included both open and laparoscopic/robotic surgery. Regional rates of RP per year, and absolute and percent changes over time were identified. Pearson correlations were calculated to determine whether baseline regional volume was associated with the magnitude of change.
Results : The mean rate of RP per 1,000 male Medicare beneficiaries was 1.33 (standard deviation=0.58) per HRR in 2004, with a range of 0.39-3.14. The mean absolute decrease in volume was -0.41 (median 0.37), range -2.20 to +1.15. There was a mean change of -20% (range -73% to +140%) between 2004-2014; median change was -27%. Regional volume in 2004 was significant correlated with the absolute decrease in RP volume in the ensuing 10 years (r=-0.82, p<0.001), as well as the percent decrease (r=-0.60, p<0.001). Despite the overall trend of decreased volume, some regions with low baseline practices had an increase in volume during the study period.
Conclusions : There is substantial regional variation in both rates of RP, and in the magnitude of change over time. High baseline surgery volume was associated with a greater decrease in volume, possibly reflecting “overuse” of RP that decreased over time. Interestingly, a subset of regions with low baseline volume had increases in volume during the study period.