The effect of minimally invasive prostatectomy on practice patterns of American urologists

Daniel T. Oberlin*, Andrew S. Flum, Jeremy D. Lai, Joshua J Meeks

*Corresponding author for this work

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Introduction and objectives: To determine how robotic prostatectomy affects practice patterns of urologists, we examined the case volume characteristics among certifying urologists for the surgical treatment of prostate cancer. We hypothesized that the utilization of open and robotic prostatectomy as well as lymph node dissection changed dynamically over the last 10 years. Methods: A total of 6-month case log data of certifying urologists from 2003 to 2013 were obtained for the American Board of Urology. Cases were identified using Current Procedural Terminology codes for open radical prostatectomy (ORP) and laparoscopic or robotic-assisted laparoscopic prostatectomy (RALP) with a corresponding diagnosis of prostate cancer as defined by ICD-9 code 185.0. Results obtained: A total of 6,563 urologists submitted case logs, of which 68% (4,470/6,563) reported performing at least one radical prostatectomy (RP), totaling 46,030 RPs logged. There was a 376% increase in the performance of RALP over the study period with robotic volume increasing from 22% of all RP in 2003 to 85% in 2013.Among surgeons performing ORP, the median number performed was 2; of surgeons who performed RALP, the median number performed was 8 (P<0.001). Overall, 39% of surgeons logging ORP performed 2 or fewer RP, whereas 19% of surgeons who performed RALP performed 2 or less RP (P<0.001). The highest volume robotic surgeons (top 10% surgical volume) performed 41% of all RALP with the highest performing robotic surgeon recording 658 prostatectomies over 6 months. Oncologists represented 4.1% of all surgeons performing RP and performed 15.1% of all RP (P<0.001); general urologists performed the majority of RP (57.8%). When performed open, there was no influence of surgeon specialty on the performance of lymph node dissection (LND); if performed robotically, oncologists were significantly more likely to perform LND compared with general surgeons (47% vs. 25.9%, respectively, P<0.001). Conclusions: Robotic prostatectomies are performed 5 times more commonly than open prostatectomy and represent 85% of all RP performed by board-certified urologists in 2013. Compared to RALP, ORP are significantly more likely to be performed by lower volume surgeons. Oncologists perform a higher relative percentage of RPs and are significantly more likely to perform LND if performed robotically when compared with general urologists.

Original languageEnglish (US)
Pages (from-to)255.e1-255.e5
JournalUrologic Oncology: Seminars and Original Investigations
Volume34
Issue number6
DOIs
StatePublished - Jun 1 2016

Fingerprint

Prostatectomy
Robotics
Lymph Node Excision
Urologists
International Classification of Diseases
Prostatic Neoplasms
Current Procedural Terminology
Surgeons

Keywords

  • American board of urology
  • Practice patterns
  • Prostate cancer
  • Robotic prostatectomy

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

@article{3a255c86966f48c8952e93569b88700e,
title = "The effect of minimally invasive prostatectomy on practice patterns of American urologists",
abstract = "Introduction and objectives: To determine how robotic prostatectomy affects practice patterns of urologists, we examined the case volume characteristics among certifying urologists for the surgical treatment of prostate cancer. We hypothesized that the utilization of open and robotic prostatectomy as well as lymph node dissection changed dynamically over the last 10 years. Methods: A total of 6-month case log data of certifying urologists from 2003 to 2013 were obtained for the American Board of Urology. Cases were identified using Current Procedural Terminology codes for open radical prostatectomy (ORP) and laparoscopic or robotic-assisted laparoscopic prostatectomy (RALP) with a corresponding diagnosis of prostate cancer as defined by ICD-9 code 185.0. Results obtained: A total of 6,563 urologists submitted case logs, of which 68{\%} (4,470/6,563) reported performing at least one radical prostatectomy (RP), totaling 46,030 RPs logged. There was a 376{\%} increase in the performance of RALP over the study period with robotic volume increasing from 22{\%} of all RP in 2003 to 85{\%} in 2013.Among surgeons performing ORP, the median number performed was 2; of surgeons who performed RALP, the median number performed was 8 (P<0.001). Overall, 39{\%} of surgeons logging ORP performed 2 or fewer RP, whereas 19{\%} of surgeons who performed RALP performed 2 or less RP (P<0.001). The highest volume robotic surgeons (top 10{\%} surgical volume) performed 41{\%} of all RALP with the highest performing robotic surgeon recording 658 prostatectomies over 6 months. Oncologists represented 4.1{\%} of all surgeons performing RP and performed 15.1{\%} of all RP (P<0.001); general urologists performed the majority of RP (57.8{\%}). When performed open, there was no influence of surgeon specialty on the performance of lymph node dissection (LND); if performed robotically, oncologists were significantly more likely to perform LND compared with general surgeons (47{\%} vs. 25.9{\%}, respectively, P<0.001). Conclusions: Robotic prostatectomies are performed 5 times more commonly than open prostatectomy and represent 85{\%} of all RP performed by board-certified urologists in 2013. Compared to RALP, ORP are significantly more likely to be performed by lower volume surgeons. Oncologists perform a higher relative percentage of RPs and are significantly more likely to perform LND if performed robotically when compared with general urologists.",
keywords = "American board of urology, Practice patterns, Prostate cancer, Robotic prostatectomy",
author = "Oberlin, {Daniel T.} and Flum, {Andrew S.} and Lai, {Jeremy D.} and Meeks, {Joshua J}",
year = "2016",
month = "6",
day = "1",
doi = "10.1016/j.urolonc.2016.01.008",
language = "English (US)",
volume = "34",
pages = "255.e1--255.e5",
journal = "Urologic Oncology",
issn = "1078-1439",
publisher = "Elsevier Inc.",
number = "6",

}

The effect of minimally invasive prostatectomy on practice patterns of American urologists. / Oberlin, Daniel T.; Flum, Andrew S.; Lai, Jeremy D.; Meeks, Joshua J.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 34, No. 6, 01.06.2016, p. 255.e1-255.e5.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The effect of minimally invasive prostatectomy on practice patterns of American urologists

AU - Oberlin, Daniel T.

AU - Flum, Andrew S.

AU - Lai, Jeremy D.

AU - Meeks, Joshua J

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Introduction and objectives: To determine how robotic prostatectomy affects practice patterns of urologists, we examined the case volume characteristics among certifying urologists for the surgical treatment of prostate cancer. We hypothesized that the utilization of open and robotic prostatectomy as well as lymph node dissection changed dynamically over the last 10 years. Methods: A total of 6-month case log data of certifying urologists from 2003 to 2013 were obtained for the American Board of Urology. Cases were identified using Current Procedural Terminology codes for open radical prostatectomy (ORP) and laparoscopic or robotic-assisted laparoscopic prostatectomy (RALP) with a corresponding diagnosis of prostate cancer as defined by ICD-9 code 185.0. Results obtained: A total of 6,563 urologists submitted case logs, of which 68% (4,470/6,563) reported performing at least one radical prostatectomy (RP), totaling 46,030 RPs logged. There was a 376% increase in the performance of RALP over the study period with robotic volume increasing from 22% of all RP in 2003 to 85% in 2013.Among surgeons performing ORP, the median number performed was 2; of surgeons who performed RALP, the median number performed was 8 (P<0.001). Overall, 39% of surgeons logging ORP performed 2 or fewer RP, whereas 19% of surgeons who performed RALP performed 2 or less RP (P<0.001). The highest volume robotic surgeons (top 10% surgical volume) performed 41% of all RALP with the highest performing robotic surgeon recording 658 prostatectomies over 6 months. Oncologists represented 4.1% of all surgeons performing RP and performed 15.1% of all RP (P<0.001); general urologists performed the majority of RP (57.8%). When performed open, there was no influence of surgeon specialty on the performance of lymph node dissection (LND); if performed robotically, oncologists were significantly more likely to perform LND compared with general surgeons (47% vs. 25.9%, respectively, P<0.001). Conclusions: Robotic prostatectomies are performed 5 times more commonly than open prostatectomy and represent 85% of all RP performed by board-certified urologists in 2013. Compared to RALP, ORP are significantly more likely to be performed by lower volume surgeons. Oncologists perform a higher relative percentage of RPs and are significantly more likely to perform LND if performed robotically when compared with general urologists.

AB - Introduction and objectives: To determine how robotic prostatectomy affects practice patterns of urologists, we examined the case volume characteristics among certifying urologists for the surgical treatment of prostate cancer. We hypothesized that the utilization of open and robotic prostatectomy as well as lymph node dissection changed dynamically over the last 10 years. Methods: A total of 6-month case log data of certifying urologists from 2003 to 2013 were obtained for the American Board of Urology. Cases were identified using Current Procedural Terminology codes for open radical prostatectomy (ORP) and laparoscopic or robotic-assisted laparoscopic prostatectomy (RALP) with a corresponding diagnosis of prostate cancer as defined by ICD-9 code 185.0. Results obtained: A total of 6,563 urologists submitted case logs, of which 68% (4,470/6,563) reported performing at least one radical prostatectomy (RP), totaling 46,030 RPs logged. There was a 376% increase in the performance of RALP over the study period with robotic volume increasing from 22% of all RP in 2003 to 85% in 2013.Among surgeons performing ORP, the median number performed was 2; of surgeons who performed RALP, the median number performed was 8 (P<0.001). Overall, 39% of surgeons logging ORP performed 2 or fewer RP, whereas 19% of surgeons who performed RALP performed 2 or less RP (P<0.001). The highest volume robotic surgeons (top 10% surgical volume) performed 41% of all RALP with the highest performing robotic surgeon recording 658 prostatectomies over 6 months. Oncologists represented 4.1% of all surgeons performing RP and performed 15.1% of all RP (P<0.001); general urologists performed the majority of RP (57.8%). When performed open, there was no influence of surgeon specialty on the performance of lymph node dissection (LND); if performed robotically, oncologists were significantly more likely to perform LND compared with general surgeons (47% vs. 25.9%, respectively, P<0.001). Conclusions: Robotic prostatectomies are performed 5 times more commonly than open prostatectomy and represent 85% of all RP performed by board-certified urologists in 2013. Compared to RALP, ORP are significantly more likely to be performed by lower volume surgeons. Oncologists perform a higher relative percentage of RPs and are significantly more likely to perform LND if performed robotically when compared with general urologists.

KW - American board of urology

KW - Practice patterns

KW - Prostate cancer

KW - Robotic prostatectomy

UR - http://www.scopus.com/inward/record.url?scp=84959255051&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959255051&partnerID=8YFLogxK

U2 - 10.1016/j.urolonc.2016.01.008

DO - 10.1016/j.urolonc.2016.01.008

M3 - Article

C2 - 26935867

AN - SCOPUS:84959255051

VL - 34

SP - 255.e1-255.e5

JO - Urologic Oncology

JF - Urologic Oncology

SN - 1078-1439

IS - 6

ER -