To assess the relative contributions of patient and surgeon factors for predicting selection of ileal conduit (IC), neobladder (NB), or continent pouch (CP) urinary diversions (UD) for patients diagnosed with muscle-invasive/high-risk non-muscle invasive bladder cancer. This information is needed to enhance research comparing cancer survivors' outcomes across different surgical treatment options.
Bladder cancer patients age ≥21 years with cystectomy/UD performed from 1/2010 to 6/2015 in three Kaiser Permanente regions were included. All patient and surgeon data were obtained from electronic health records. A mixed effects logistic regression model was used treating surgeon as a random effect and region as a fixed effect.
Of 991 eligible patients, 794 (80%) received IC. 169 surgeons performed the surgeries and accounted for a sizeable proportion of the variability in patient receipt of UD (ICC=.26). The multilevel model with only patient factors showed good fit (AUC=.93, Hosmer-Lemeshow test p=.44), and older age, female sex, eGFR<45, 4+ comorbidity index score, and stage III/IV tumors were associated with higher odds of receiving an IC vs. NB/CP. However, including surgeon factors (annual cystectomy volume, specialty training, clinical tenure) had no association (p=.29).
In this community setting, patient factors were major predictors of UD received. Surgeons also played a substantial role, yet clinical training and experience were not major predictors. Surgeon factors such as beliefs about UD options and outcomes should be explored.
Urology. 2018 Nov 21 [Epub ahead of print]
Marilyn L Kwan, Michael C Leo, Kim N Danforth, Sheila Weinmann, Valerie S Lee, Julie R Munneke, Joanna E Bulkley, Maureen O'Keeffe Rosetti, David K Yi, Matthew P Banegas, Matthew D Wagner, Stephen G Williams, David S Aaronson, Marcia Grant, Robert S Krouse, Scott M Gilbert, Carmit K McMullen
Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612. Electronic address: ., Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR 97227., Kaiser Permanente Department of Research & Evaluation, 100 South Los Robles Avenue, Pasadena, CA 91101., Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612., Department of Urology, Kaiser Permanente Sunnyside Medical Center, 10180 SE Sunnyside Rd, Clackamas, OR 97015., Department of Urology, Kaiser Permanente Riverside Medical Center, 10800 Magnolia Avenue, Riverside, CA 92505., Department of Urology, Kaiser Permanente Oakland Medical Center, 280 W MacArthur Blvd, Oakland, CA 94611., City of Hope Hospital, 1500 Duarte Rd, Duarte, CA 91010., University of Pennsylvania School of Medicine, University & Woodland Aves., Mail Stop 642/112, Surgery, Philadelphia, PA 19104., H. Lee Moffitt Cancer Center & Research Institute, 12902 Usf Magnolia Dr, Tampa, FL 33612.