Table 2.
Treating Urologist Volume, Type of Surgery and Surgical Outcomes by Whether the Patient Had a Different Diagnosing and Treating Urologist, SEER-Medicare 1995 to 2005
| Unadjusted |
Propensity Score Weighted* |
|||||
|---|---|---|---|---|---|---|
| No Change | Urologist Change | p-value | No Change | Urologist Change | p-value | |
| Diagnosing urologist characteristics | ||||||
| Volume status | ||||||
| Low | 12,121 (78.9) | 8,302 (95.5) | <.001 | 8,287 (95.4) | 8,302 (95.5) | .040 |
| High | 3,248 (21.1) | 390 (4.5) | 398 (4.6) | 390 (4.5) | ||
| Board certified | ||||||
| No | 3,763 (24.5) | 2,357 (27.1) | <.001 | 2,454 (28.3) | 2,357 (27.1) | .648 |
| Yes | 11,606 (75.5) | 6,335 (72.9) | 6,231 (71.7) | 6,335 (72.9) | ||
| Years since medical school graduation† | ||||||
| Top quartile (oldest) | 3,498 (22.8) | 2,319 (26.7) | <.001 | 2,226 (25.6) | 2,319 (26.7) | .816 |
| Middle top quartile | 5,242 (34.1) | 2,561 (29.5) | 2,472 (28.5) | 2,561 (29.5) | ||
| Middle bottom quartile | 4,929 (32.1) | 2,454 (28.2) | 2,472 (28.5) | 2,454 (28.2) | ||
| Lowest quartile (youngest) | 1,700 (11.1) | 1,358 (15.6) | 1,516 (17.5) | 1,358 (15.6) | ||
| Treating urologist characteristics | ||||||
| Volume status | ||||||
| Low | 12,121 (78.9) | 5,853 (67.3) | <.001 | 8,287 (95.4) | 5,853 (67.3) | <.001 |
| High | 3,248 (21.1) | 2,839 (32.7) | 398 (4.6) | 2,839 (32.7) | ||
| Board certified | ||||||
| No | 3,763 (24.5) | 2,397 (27.6) | <.001 | 2,454 (28.3) | 2,397 (27.6) | .858 |
| Yes | 11,606 (75.5) | 6,295 (72.4) | 6,231 (71.7) | 6,295 (72.4) | ||
| Years since medical school graduation† | ||||||
| Top quartile (oldest) | 3,498 (22.8) | 1,694 (19.5) | <.001 | 2,226 (25.6) | 1,694 (19.5) | .005 |
| Middle top quartile | 5,242 (34.1) | 2,488 (28.6) | 2,472 (28.5) | 2,488 (28.6) | ||
| Middle bottom quartile | 4,929 (32.1) | 3,143 (36.2) | 2,472 (28.5) | 3,143 (36.2) | ||
| Lowest quartile (youngest) | 1,700 (11.1) | 1,367 (15.7) | 1,516 (17.5) | 1,367 (15.7) | ||
| Experience with minimally invasive procedures | ||||||
| No | 14,685 (95.5) | 7,343 (84.5) | <.001 | 7,365 (84.8) | 7,343 (84.5) | .089 |
| Yes | 6,84 (4.4) | 1,349 (15.5) | 1,320 (15.2) | 1,349 (15.5) | ||
| Patient outcomes | ||||||
| 30-day surgical complications | ||||||
| None | 11,447 (74.5) | 6,768 (77.9) | <.001 | 6,447 (74.2) | 6,768 (77.9) | <.001 |
| At least one | 3,922 (25.5) | 1,924 (22.1) | 2,238 (25.8) | 1,924 (22.1) | ||
| Urinary complications | ||||||
| None | 9,549 (62.1) | 5,427 (62.4) | .650 | 5,256 (60.5) | 5,427 (62.4) | .115 |
| At least one | 5,820 (37.9) | 3,265 (37.6) | 3,428 (39.5) | 3,265 (37.6) | ||
| Long-term incontinence | ||||||
| None | 11,940 (77.7) | 6,898 (79.4) | .003 | 6,846 (78.8) | 6,898 (79.4) | .108 |
| At least one | 3,429 (22.3) | 1,794 (20.6) | 1,838 (21.2) | 1,794 (20.6) | ||
Note. The propensity score model included patient age, race, comorbidities, marital status, tumor grade and stage, type of procedure, area income, diagnosing physician board certification, years since medical school graduation experience, and surgical volume, treating physician experience with laparoscopic or robotic procedures, SEER-site, and diagnosis year.
Bivariate statistics calculated using R survey program where propensity score weight is such that the treated individual receives a weight of 1 while control individuals are weighted by ei/(1 − ei), where e is the propensity score.
Years since medical school graduation was calculated as the number of years between 2005 and graduation year. This variable was then categorized into quartiles based on the physician distribution.