The impact of gender on use of pelvic lymphadenectomy at the time of radical cystectomy Journal Article
| Authors: | Anderson, C. B.; Alvarez, J.; Koyama, T.; Penson, D. F.; Barocas, D. A. |
| Article Title: | The impact of gender on use of pelvic lymphadenectomy at the time of radical cystectomy |
| Abstract: | Introduction: Although women are less likely to be diagnosed with bladder cancer than men, they experience a disproportionally high rate of cancer specific mortality. Underuse of evidence-based processes of care may contribute to this mortality difference. We explored variation in the use of pelvic lymphadenectomy at the time of radical cystectomy between men and women, and determined if this was impacted by surgeon or hospital volume. Methods: We identified all patients with bladder cancer who underwent radical cystectomy from 1996 to 2009 in the New York, Maryland and Florida State Inpatient Databases. The effect of gender on the use of pelvic lymphadenectomy was analyzed using multivariate logistic regression models. Results: Approximately 25% of our cohort was female. Compared to men, women were less likely to be treated with pelvic lymphadenectomy (54% vs 60%, p <0.001), and tended to be treated by lower volume surgeons and at lower volume hospitals. Women had 21% lower odds (95% CI 5-35) of undergoing pelvic lymphadenectomy compared to men when adjusting for patient characteristics, even when treated by high volume surgeons and at high volume hospitals. Conclusions: At radical cystectomy women were less likely to undergo pelvic lymphadenectomy even when treated by high volume providers. Since pelvic lymphadenectomy is an evidence-based process of care that is associated with improved survival in patients with bladder cancer, lower use of pelvic lymphadenectomy may contribute to the lower bladder cancer survival rate observed in women. Our findings identify an opportunity toimprove quality of care in women with bladder cancer. © 2014 American Urological Association Education and Research, Inc. |
| Keywords: | adult; treatment outcome; aged; comparative study; pelvis lymphadenectomy; data base; bladder cancer; urinary bladder neoplasms; hospital; government; disease severity; surgeon; cystectomy; multivariate logistic regression analysis; gender; race; sex; healthcare disparities; human; male; female; article; icd-9-cm; state inpatient data base |
| Journal Title: | Urology Practice |
| Volume: | 1 |
| Issue: | 3 |
| ISSN: | 2352-0779 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2014-09-01 |
| Start Page: | 146 |
| End Page: | 150 |
| Language: | English |
| DOI: | 10.1016/j.urpr.2014.06.002 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 3 November 2014 -- Source: Scopus |
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