Presentation Authors: Olamide Omidele*, New York, NY, Mark Finkelstein, Khawaja Bilal, Michael Palese, New York , NY
Introduction: Radical cystectomy (RC) and pelvic lymph node dissection are the benchmark surgical treatment for men diagnosed with bladder cancer. Studies have shown that radical cystectomy is an effective treatment, but few studies have evaluated racial and socioeconomic features of patients undergoing RC. Of these studies, no study has investigated how physician and hospital volume relate to patient demographics.
Methods: Data was extracted from the New York State Statewide Planning and Research Cooperative System (SPARCS) database from 2009 to 2014. ICD-9-CM procedure code 57.71 was used to identify all radical cystectomies conducted in NYS during the study period. Patientsâ€™ diagnosis, age, race/ethnicity, primary payment method, severity of illness, length of stay, and hospital characteristics were included. All physicians were categorized into very-high-, high-, medium-, and low-volume groups. Hospitals were stratified into similar volume-based groupings.
Results: Low-volume facilities and physicians were more likely to be in rural areas and less likely to be of teaching-hospital status (p= < 0.001). 13% of patients in low-volume facility group were African-American compared with just 3% in the very-high volume facility group (p= < 0.001). Similar results were found when comparing physician volume, 10% versus 3% respectively (p= < 0.001). Medicaid patients made up a greater proportion of patients seen by low-volume physicians when compared to very-high volume physicians (p= < 0.001).
Conclusions: The results showed significant differences in hospital characteristics, racial distribution, and primary payment methods between low- and high-volume categories based on physician-level and facility-level data. Particularly, Medicaid patients and African-American patients made up a larger percentage of patients for low-volume physicians and low-volume facilities. This suggests that racial and socioeconomic disparities exist for disadvantaged groups, and this may be attributable to these groups ability to access care from high-volume physicians and facilities.