Patterns of Performance of Surgical Oncology by North American Pediatric Urologists - A Report from the Pediatric Urologic Oncology Working Group (PUOWG) of the Society of Pediatric Urology (SPU)
Nicholas G. Cost, M.D.1, Jonathan Ross, M.D.2, Fernando Ferrer, M.D.3, Armando Lorenzo, M.D.4, Margarett Shnorhavorian, M.D., M.P.H.5, Jonathan Routh, M.D., M.P.H.6, Kathleen Kieran, M.D.5, Michael Ritchey, M.D.7.
1University of Colorado School of Medicine, Aurora, CO, USA, 2University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA, 3Connecticut Children's Medical Center, Hartford, CT, USA, 4Sick Children's Hospital - Toronto, Toronto, ON, Canada, 5Seattle Children's Hospital, Seattle, WA, USA, 6Duke University Medical Center, Durham, NC, USA, 7Phoenix Children's Hospital, Phoenix, AZ, USA.
Objective data on the patterns of oncology practice amongst pediatric urologists in North America are lacking. Thus, we reviewed surgical case logs submitted to the American Board of Urology (ABU) by those self-describing as pediatric urologists.
Approval for this proposal was reviewed by the ABU publications committee. We reviewed submitted practice logs from urologists self-reporting as specializing in pediatric urology. These were logs submitted for ABU certification, re-certification or Pediatric Subspecialty Certification (PSCE) in Urology. Logs were standardized to represent a 12mo period of practice. We collected data on pediatric oncology cases, as noted by specific procedure codes linked with specific oncologic diagnosis codes on cases logged for patients ≤ 30 years-old. A descriptive analysis was done as well as a Poisson regression to identify surgeon-specific factors associated with oncology case volume.
We identified 281 submitted case logs meeting study criteria. Overall, 364 oncology cases were logged and 131 (46.6%) of the logs reported ≥1 oncology case while 150 (53.4%) reported no oncology cases. 39 (13.9%) logs reported 1 case, 56 (19.9%) reported 2, 10 (3.6%) reported 3, 13 (4.6%) reported 4, 3 (1.1%) reported 5, 4 (1.4%) reported 6, 2 (0.7%) reported 7, 1 (0.4%) reported 8, 1 (0.4%) reported 12, 1 (0.4%) reported 16, and 1 (0.4%) reported 42 cases. Thus, the 75th, 90th, 95th, and 99th percentile of oncology volume was represented by logging 2, 3, 4, and 12 cases, respectively. Interestingly, 13 (4.6%) logs accounted for over a third (35.9%) of all the oncology cases.
The most common oncology case logged was orchiectomy (radical and partial) and was reported in 83 (29.5%) logs. Nephrectomy (radical and partial) was next most common in 32 (11.4%) logs, followed by RPLND in 27 (9.6%) logs and endoscopic biopsy of bladder, prostate or pelvic malignancy in 18 (6.4%) logs. On Poisson regression, the following variables were associated with oncology volume: male gender (Incidence rate ratio (IRR) = 2.8, 95%CI 2.1-3.9), 2010 log year (IRR = 2.4, 95%CI 1.3-4.4), 2015 log year (IRR = 3.7, 95%CI 2.1-6.4), and non-PSCE logs (IRR = 1.6, 95%CI 1.2-2.3). Years of experience, AUA section, practice area population and practice type were not associated with oncology volume.
Few pediatric urologists perform a high volume of oncology surgeries based on surgical case logs submitted to the ABU. A very small cohort of pediatric urologists logged the vast majority of such cases.
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