SURPASSING RADICAL PROSTATECTOMY LEARNING CURVES: REAL WORLD EVIDENCE FROM THE NEW YORK

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making I (MP02)1 Apr 2020MP02-19 SURPASSING RADICAL PROSTATECTOMY LEARNING CURVES: REAL WORLD EVIDENCE FROM THE NEW YORK Daniel Frendl*, David Chang, Jeffrey Twum-Ampofo, and Michelle Kim Daniel Frendl*Daniel Frendl* More articles by this author , David ChangDavid Chang More articles by this author , Jeffrey Twum-AmpofoJeffrey Twum-Ampofo More articles by this author , and Michelle KimMichelle Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000816.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior work suggests that <5% of urologists performing radical prostatectomy (RP) in the U.S. have adequate annual surgical volume to achieve expertise with 250 cumulative surgeries by 10 years in practice. We sought to characterize modern-era urologists’ cumulative volume and time to surpassing 250 radical prostatectomy cases using real-world population-level data. METHODS: We identified urologists performing RP for prostate cancer from 2010-2015 in the New York (NY) Statewide Planning and Research Cooperative System (SPARCS) database during the modern robotic era and assess their cumulative RP volume from 2000-2015. NY medical license numbers were cross-referenced with the state physician licensing database and online profiles to obtain urologist training data. We limited our analysis to urologists who completed terminal training and graduated medical school ≥1990. Kaplan-Meier estimates of time from initiation of independent practice to surpassing 250 cases were computed as well as a Cox proportional hazards model assessing the impact of fellowship training status. RESULTS: We identified 25,093 RP surgeries performed by 193 urologists with median follow-up of 8 years (IQR: 4-15 years) and median years of independent practice 6 years (range 0-18). Seventy-one (37%) completed an oncology or robotics fellowship. Twenty-three urologists (12%) surpassed 250 cumulative RP during observation within a median of 7 years. Kaplan-Meier estimates revealed at 10 years of independent practice 12% of urologists surpassed 250 cumulative RP; at 18 years 39% surpassed this threshold. Among fellowship trained urologists, 35% surpassed 250 RP at 10 years and half surpassed 250 RP at 15 years. Fellowship trained urologists had a 10.7-fold higher hazards (p<0.001) of achieving 250 RP compared to non-fellowship trained surgeons (Fig 1). CONCLUSIONS: Thirty-nine percent of urologists performing radical prostatectomy surpass a rigorous learning curve threshold of 250 cumulative surgeries during their first two decades in practice with a median time of 7 years. Fellowship trained urologists are far more likely to achieve this learning curve plateau and half achieve this goal around 15 years into independent practice. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e19-e20 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Frendl* More articles by this author David Chang More articles by this author Jeffrey Twum-Ampofo More articles by this author Michelle Kim More articles by this author Expand All Advertisement PDF downloadLoading ...