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Urology. 2019 Mar;125:222-229. doi: 10.1016/j.urology.2018.09.037. Epub 2018 Nov 22.

Factors That Influence Selectionof Urinary Diversion Among Bladder Cancer Patients in 3 Community-based Integrated Health Care Systems.

Author information

1
Kaiser Permanente Division of Research, Oakland, CA. Electronic address: Marilyn.L.Kwan@kp.org.
2
Kaiser Permanente Center for Health Research, Portland, OR.
3
Kaiser Permanente Department of Research & Evaluation, Pasadena, CA.
4
Kaiser Permanente Division of Research, Oakland, CA.
5
Department of Urology, Kaiser Permanente Sunnyside Medical Center, Clackamas, OR.
6
Department of Urology, Kaiser Permanente Riverside Medical Center, Riverside, CA.
7
Department of Urology, Kaiser Permanente Oakland Medical Center, Oakland, CA.
8
City of Hope Hospital, Duarte, CA.
9
University of Pennsylvania School of Medicine, University & Woodland Aves., Philadelphia, PA.
10
H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.

Abstract

OBJECTIVE:

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 nonmuscle invasive bladder cancer. This information is needed to enhance research comparing cancer survivors' outcomes across different surgical treatment options.

METHODS:

Bladder cancer patients' age ≥21 years with cystectomy/UD performed from January 2010 to June 2015 in 3 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.

RESULTS:

Of 991 eligible patients, 794 (80%) received IC. One hundred sixty-nine surgeons performed the surgeries and accounted for a sizeable proportion of the variability in patient receipt of UD (intraclass correlation coefficient = 0.26). The multilevel model with only patient factors showed good fit (area under the curve = 0.93, Hosmer-Lemeshow test P = .44), and older age, female sex, estimated glomerular filtration rate <45, 4+ comorbidity index score, and stage III/IV tumors were associated with higher odds of receiving an IC vs neobladder/continent pouch. However, including surgeon factors (annual cystectomy volume, specialty training, clinical tenure) had no association (P = .29).

CONCLUSION:

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.

Comment in

PMID:
30471370
PMCID:
PMC6389399
[Available on 2020-03-01]
DOI:
10.1016/j.urology.2018.09.037
[Indexed for MEDLINE]

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