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JAMA Intern Med. 2018 Feb 1;178(2):221-227. doi: 10.1001/jamainternmed.2017.7508.

Regional Variation of Computed Tomographic Imaging in the United States and the Risk of Nephrectomy.

Author information

1
Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire.
2
Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
3
Veterans Affairs Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont.
4
Department of Economics, Dartmouth College, Hanover, New Hampshire.
5
Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
6
Urology Service, Department of Veterans Affairs Medical Center, White River Junction, Vermont.
7
Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.

Abstract

Importance:

While computed tomography (CT) represents a tremendous advance in diagnostic imaging, it also creates the problem of incidental detection-the identification of tumors unrelated to the clinical symptoms that initiate the test.

Objective:

To determine the geographic variation in the United States in CT imaging and the corresponding association with one of the most consequential sequelae of incidental detection: nephrectomy.

Design, Setting, and Participants:

This study is a cross-sectional analysis of age-, sex-, and race-adjusted Medicare data (January 2010-December 2014) from 306 hospital referral regions (HRRs) in the United States and includes information from 15 million fee-for-service Medicare beneficiaries age 65 to 85 years.

Exposures:

Regional CT risk (ie, the proportion of the population receiving either a chest or abdominal CT over 5 years).

Main Outcomes and Measures:

Five-year risk of nephrectomy (partial or total).

Results:

Data from 15 million fee-for-service Medicare beneficiaries age 65 to 85 years were gathered and illustrate that 43% of Medicare beneficiaries age 65 to 85 years received either a chest or abdominal CT from January 2010 to December 2014. This risk varied across the HRRs, ranging from 31% in Santa Cruz, California, to 52% in Sun City, Arizona. Increased regional CT risk was associated with a higher nephrectomy risk (r = 0.38; 95% CI, 0.28-0.47), particularly among HRRs with more than 50 000 beneficiaries (r = 0.47; 95% CI, 0.31-0.61). After controlling for HRR adult smoking rates, imaging an additional 1000 beneficiaries was associated with 4 additional nephrectomies (95% CI, 3-5). Case-fatality rates for those who underwent nephrectomy were 2.1% at 30 days and 4.3% at 90 days.

Conclusions and Relevance:

Fee-for-service Medicare beneficiaries are commonly exposed to CT imaging. Those residing in high-scanning regions face a higher risk of nephrectomy, presumably reflecting the incidental detection of renal masses. Additional surgery should be considered one of the risks of excessive CT imaging.

PMID:
29279887
PMCID:
PMC5838611
DOI:
10.1001/jamainternmed.2017.7508
[Indexed for MEDLINE]
Free PMC Article

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