Significant Management Variability of Urethral stricture Disease in United States: Data from the AUA Quality (AQUA) Registry.
Adult
Age Factors
Aged
Aged, 80 and over
Disease Management
Endoscopy
/ statistics & numerical data
Humans
Male
Medical Overuse
/ statistics & numerical data
Middle Aged
Practice Patterns, Physicians'
/ statistics & numerical data
Plastic Surgery Procedures
/ statistics & numerical data
Registries
Reoperation
/ statistics & numerical data
United States
Urethra
/ surgery
Urethral Stricture
/ therapy
Journal
Urology
ISSN: 1527-9995
Titre abrégé: Urology
Pays: United States
ID NLM: 0366151
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
17
06
2020
revised:
26
07
2020
accepted:
29
07
2020
pubmed:
11
8
2020
medline:
1
3
2022
entrez:
11
8
2020
Statut:
ppublish
Résumé
To determine the degree of contemporary practice variation for the treatment of urethral stricture disease (USD) given repeated endoscopic management yields poor long-term success. The AUA Quality (AQUA) Registry collects data from participating urologists across practice settings by direct interface with local electronic health record systems. We identified procedures used for USD using Current Procedural Terminology (CPT) and International Statistical Classification of Diseases (ICD-9/-10) codes. We assessed the association between patient and provider factors and repeated endoscopic treatment using generalized linear models. Provider details were derived from AUA Census. We identified 20,640 male patients with USD treated surgically in AQUA from 2014-2018. The patients were cared for by 1343 providers at 171 practices, 95% of these community-based. Among patients with USD who had treatment, 20,101(97.9%) underwent endoscopic management. 6218(31%) underwent repeated endoscopic treatment during the study period. Urethroplasty was performed in 539(2.6%) patients. Median patient age at first procedure for endoscopic surgery vs. urethroplasty was 73 vs. 39 years old, respectively (p<0.001). At the practice level, significant variation in rates of repeated endoscopic management was noted. Patients of older age (OR=1.08, 95%CI: 1.06-1.11 for ages ≥80) and patients with a bladder cancer diagnosis (OR=1.17, 95%CI: 1.15-1.20) had higher odds of receiving repeated endoscopic management. Increasing practitioner age was also associated with increased odds of repeated endoscopic management. (OR=1.13, 95%CI: 1.11- 1.16, for practitioners ≥64). Repeated endoscopic management for USD is overused. The utilization of endoscopic management is variable across practices and frequently guideline-discordant, presenting an opportunity for quality improvement.
Identifiants
pubmed: 32777368
pii: S0090-4295(20)30968-7
doi: 10.1016/j.urology.2020.07.053
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
265-270Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.