A population-based study of surgeon characteristics associated with the uptake of contemporary techniques in renal
Stanley A Yap1, Shabbir M H Alibhai, David Margel
1Division of Urologic Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON;
Introduction:
We have witnessed the slow uptake of many contemporary techniques in the surgical management of renal tumours. We sought to evaluate surgeon-level characteristics associated with the uptake of laparoscopy, partial nephrectomy (PN) and adrenal-sparing approaches in surgically managing these tumours.
Methods:
Using the Ontario Cancer Registry, we identified surgeons treating renal cell carcinoma (RCC) in the province of Ontario, Canada between 2002 and 2004. We then classified individuals within this cohort as either high or low utilizers of laparoscopy, PN or adrenal-sparing approaches. Further variables analyzed included academic status, surgeon graduation year and surgical volume status. We then used univariable and multivariable logistic regression models to assess predictors of uptake.
Results:
We evaluated a total of 108 surgeons for their uptake of both laparoscopy and adrenal-sparing approaches and 94 surgeons for their uptake of PN. We identified 32 surgeons (30%) as high users of laparoscopy. Predictors of uptake of laparoscopy included graduation year after 1990 (odds ratio [OR] 4.81, confidence interval [CI] 1.57-14.8) and high-surgeon volume (OR 4.33, CI 1.60-10.4). We identified 41 surgeons (44%) as high users of PN. The only predictor of uptake of PN was academic status (OR 5.83, CI 1.96-17.3). We identified 69 surgeons (65%) as high users of adrenal-sparing approaches, but did not identify any significant predictors for uptake in this group.
Discussion:
We identify unique factors contributing to the uptake of distinct surgical techniques in the management of RCC. This information sheds lights on the underlying mechanisms and helps us understand how to further encourage the dissemination of these practices.
Insights
Surgeon characteristics influence adoption of new kidney cancer surgeries. Graduating after 1990 and high surgical volume predict laparoscopy use, while academic status predicts partial nephrectomy adoption.
Area of Science:
- Urology
- Surgical Oncology
- Health Services Research
Background:
- Contemporary surgical techniques for renal tumors show slow adoption.
- Understanding surgeon-level factors is crucial for improving surgical practice patterns.
Purpose of the Study:
- To evaluate surgeon characteristics associated with the uptake of laparoscopy, partial nephrectomy (PN), and adrenal-sparing approaches in renal tumor management.
- To identify predictors for the adoption of minimally invasive and organ-sparing surgical techniques.
Main Methods:
- Analysis of the Ontario Cancer Registry data for surgeons treating renal cell carcinoma (RCC) between 2002-2004.
- Classification of surgeons into high/low utilizers of specific surgical approaches.
- Logistic regression models to assess predictors including academic status, graduation year, and surgical volume.
Main Results:
- 30% of surgeons were high users of laparoscopy; predictors included graduation after 1990 (OR 4.81) and high surgical volume (OR 4.33).
- 44% of surgeons were high users of partial nephrectomy (PN); academic status was the only predictor (OR 5.83).
- 65% of surgeons were high users of adrenal-sparing approaches, with no significant predictors identified.
Conclusions:
- Unique surgeon-level factors influence the adoption of different surgical techniques for renal tumors.
- Findings provide insights into mechanisms of practice change and strategies for promoting advanced surgical methods.
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