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154 NATIONWIDE TRENDS IN PENILE FRACTURE REPAIR: WHAT ELSE MATTERS?
Vol. 189, No. 4S, Supplement, Sunday, May 5, 2013
153 RURAL RESIDENCE AND BLADDER CANCER RISK: A STUDY FROM THE OREGON STATE CANCER REGISTRY Ross Anderson*, Theresa Koppie, Brian Cox, Yiyi Chen, Jeffrey LaRochelle, Christopher Amling, Portland, OR INTRODUCTION AND OBJECTIVES: Bladder cancer (BC) stage and grade are strongly associated with disease specific survival, therefore early diagnosis and treatment is imperative. Patients in rural areas may have poor access to care, and thus may be at risk for delayed bladder cancer diagnosis and treatment. We sought to investigate bladder cancer risk based on rural and urban habitation in the state of Oregon. METHODS: We used the US Census Bureau data to define ‘rural’ and ‘urban’. Urban counties have one urbanized area within its borders (census block with at least 500 people per square mile that together encompasses a population of more than 50,000). We then used the OSCaR to identify BC cases and their county of residence from 1996 to 2011. Population changes were controlled by trending 1990, 2000, and 2010 census data. Access to primary care and specialty physicians was determined using the Oregon Medical Board Annual Report. We determined associations between the risk of BC and rural county status, as well as the risk of BC and access to care using Chi-square and independent T-tests. RESULTS: During the study period 13,787 cases of BC were diagnosed, of which 4,908 (36%) were diagnosed in rural counties. The relative risk of developing BC in rural counties was 1.34 (95%CI, 1.32-1.41). Rural and urban counties have an equal percent of the general population ⬎65 years old. The rural cases were 0.6 years older (p.001) at the time of diagnosis. In rural counties, the average number of urologists was 1.63, and the ratio of population to primary care physicians was 1,410 to one. In urban counties, the average number of urologists was 19.48, and the ratio of population to primary care physicians was 1,180. Thirty one percent of the rural BC patients lived in counties without a practicing urologist at the time of diagnosis. CONCLUSIONS: Rural counties have a disproportionate burden of bladder cancer, yet these same counties have fewer physicians with the expertise to diagnose and treat bladder cancer. Further studies are necessary to determine the potential cause of this increased risk. These include environmental and occupational factors, socio-economic, and other regional differences. Source of Funding: None
154 NATIONWIDE TRENDS IN PENILE FRACTURE REPAIR: WHAT ELSE MATTERS? Puneet Masson*, Vidit Sharma, Dae Y. Kim, John Cashy, Chicago, IL; Kevin T. McVary, Springfield, IL INTRODUCTION AND OBJECTIVES: Penile fracture (PF) is an uncommon urologic calamity that frequently results in an emergency room visit. Favorable outcomes have been reported regarding preservation of erectile function in patients who undergo immediate repair. Timing of fracture, surgeon experience, and clinical parameters influence the decision to proceed with immediate repair compared to observation. Therefore, our objective is to determine PF rates in the US, and examine patient demographic and geographic practice patterns for corrective surgical repair. METHODS: This study used years 2006 - 2009 of the Nationwide Emergency Department Sample (NEDS) to identify patients who presented with a PF and also selected those who subsequently underwent surgical repair. Patients were stratified by various demographic and socioecononomic parameters to compare differences in rates for those who underwent surgery versus those who were observed and/or discharged. RESULTS: 1144 patients in the NEDS 2006-2009 presented with PF and 275 (24.0%) underwent surgical repair. Steady rates of surgical repair were observed during the study period. The mean age of
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PF presentation was 37 years (SD ⫽ 11.8) with no meaningful difference noted in age among patients who underwent surgery versus patients who were observed. Men treated with surgery were more likely to have private insurance than government assistance/uninsured (26.6% vs 21.7%, p ⫽ 0.0001. Corrective surgery was more likely when patients presented in a teaching hospital (27.8% vs 23.2%, p ⬍ 0.001), a trauma center (27.7% vs 22.2%, p ⫽ 0.0001), or a metropolitan hospital (29.9% vs 17.7%, p ⬍ 0.0001). Patients who presented with a PF in the Northeast were more likely to have surgery than those presenting in other parts of the country (Northeast 39.5%, Midwest 18.0%, South 21.4%, West 25.7%, p ⬍ 0.0001). There was a mild statistical difference in PF surgery favoring patients who presented during the weekend versus during the week (26.4% vs 23.1%, p ⫽ 0.007), but perhaps without clinical relevance. CONCLUSIONS: Given the assumption that the main factors driving corrective surgery for PF are time from injury and surgeon experience, it is striking to recognize the disparity in PF repair across demographic and socioeconomic parameters. Our study highlights the influence that hospital setting and patient insurance can have over treatment for PF and the need for a more focused analysis on patients presenting with this potentially correctable condition. Source of Funding: Havana Day Dreamers Foundation, SMSNA Fellowship Scholar 2012, SIU Urology Endowment Fund.
155 THE INCIDENCE OF VTE AND MAJOR BLEEDING EVENTS IN MAJOR UROLOGIC SURGERY: A POPULATION-BASED ANALYSIS Stephen Reese*, Aaron Lay, Jeffrey Leow, Daniel Welchons, Boston, MA; Benjamin Chung, Palo Alto, CA; Steven Chang, Boston, MA INTRODUCTION AND OBJECTIVES: Venous Thromboembolism (VTE), which comprises deep venous thrombosis (DVT) and pulmonary embolism (PE), represent a major burden on the United States healthcare system, with an increased risk for postoperative patients and patients with malignancy. The true incidence of VTE for major urologic surgery is poorly defined. We performed a populationbased analysis to determine the incidence of symptomatic VTEs, DVTs, PEs and major bleeding following major urologic surgery. We also identified independent predictors of predisposing risk factors for VTE and major bleeding events. METHODS: We captured all adult patients who underwent major urologic surgery between January 2003 and December 2010 based on 1CD-9-CM codes from the Perspective Database (Premier, Inc, Charlotte, NC), a nationally represented dataset capturing 20% of US hospital discharges. Major urologic surgery was defined as either a radical prostatectomy, radical cystectomy, radical nephrectomy or partial nephrectomy. We used ICD-9-CM codes to identify VTE and major bleeding after major urologic surgery. Univariate and multivariate analyses were performed by STATA after adjusting for sample weights. RESULTS: We captured n⫽922,559 total patients in our sample. Patients undergoing radical cystectomy had the highest rate of VTE (4.96%) and major bleeding (7.7%), while patients who underwent radical prostatectomy had the lowest rates of VTE (0.55%) and major bleeding (1.77%) (Table 1). Age over 70 was a significant risk factor for VTE (OR 6.10 p⬍0.001). Patients treated at teaching hospitals had a lower risk for VTE (0.85 p⬍0.001), but also had a higher risk for major bleeding (OR 1.06, p⬍0.001)(Fig. 1). CONCLUSIONS: Patients who had radical cystectomy had the highest incidence of VTE and major bleeding events. Higher utilization rates of peri-operative pharmacologic anticoagulation at teaching hospitals may be associated with a lower risk of VTE, but at the expense of higher risk of bleeding events.
153 RURAL RESIDENCE AND BLADDER CANCER RISK: A STUDY FROM THE OREGON STATE CANCER REGISTRY Ross Anderson*, Theresa Koppie, Brian Cox, Yiyi Chen, Jeffrey LaRochelle, Christopher Amling, Portland, OR INTRODUCTION AND OBJECTIVES: Bladder cancer (BC) stage and grade are strongly associated with disease specific survival, therefore early diagnosis and treatment is imperative. Patients in rural areas may have poor access to care, and thus may be at risk for delayed bladder cancer diagnosis and treatment. We sought to investigate bladder cancer risk based on rural and urban habitation in the state of Oregon. METHODS: We used the US Census Bureau data to define ‘rural’ and ‘urban’. Urban counties have one urbanized area within its borders (census block with at least 500 people per square mile that together encompasses a population of more than 50,000). We then used the OSCaR to identify BC cases and their county of residence from 1996 to 2011. Population changes were controlled by trending 1990, 2000, and 2010 census data. Access to primary care and specialty physicians was determined using the Oregon Medical Board Annual Report. We determined associations between the risk of BC and rural county status, as well as the risk of BC and access to care using Chi-square and independent T-tests. RESULTS: During the study period 13,787 cases of BC were diagnosed, of which 4,908 (36%) were diagnosed in rural counties. The relative risk of developing BC in rural counties was 1.34 (95%CI, 1.32-1.41). Rural and urban counties have an equal percent of the general population ⬎65 years old. The rural cases were 0.6 years older (p.001) at the time of diagnosis. In rural counties, the average number of urologists was 1.63, and the ratio of population to primary care physicians was 1,410 to one. In urban counties, the average number of urologists was 19.48, and the ratio of population to primary care physicians was 1,180. Thirty one percent of the rural BC patients lived in counties without a practicing urologist at the time of diagnosis. CONCLUSIONS: Rural counties have a disproportionate burden of bladder cancer, yet these same counties have fewer physicians with the expertise to diagnose and treat bladder cancer. Further studies are necessary to determine the potential cause of this increased risk. These include environmental and occupational factors, socio-economic, and other regional differences. Source of Funding: None
154 NATIONWIDE TRENDS IN PENILE FRACTURE REPAIR: WHAT ELSE MATTERS? Puneet Masson*, Vidit Sharma, Dae Y. Kim, John Cashy, Chicago, IL; Kevin T. McVary, Springfield, IL INTRODUCTION AND OBJECTIVES: Penile fracture (PF) is an uncommon urologic calamity that frequently results in an emergency room visit. Favorable outcomes have been reported regarding preservation of erectile function in patients who undergo immediate repair. Timing of fracture, surgeon experience, and clinical parameters influence the decision to proceed with immediate repair compared to observation. Therefore, our objective is to determine PF rates in the US, and examine patient demographic and geographic practice patterns for corrective surgical repair. METHODS: This study used years 2006 - 2009 of the Nationwide Emergency Department Sample (NEDS) to identify patients who presented with a PF and also selected those who subsequently underwent surgical repair. Patients were stratified by various demographic and socioecononomic parameters to compare differences in rates for those who underwent surgery versus those who were observed and/or discharged. RESULTS: 1144 patients in the NEDS 2006-2009 presented with PF and 275 (24.0%) underwent surgical repair. Steady rates of surgical repair were observed during the study period. The mean age of
THE JOURNAL OF UROLOGY姞
e63
PF presentation was 37 years (SD ⫽ 11.8) with no meaningful difference noted in age among patients who underwent surgery versus patients who were observed. Men treated with surgery were more likely to have private insurance than government assistance/uninsured (26.6% vs 21.7%, p ⫽ 0.0001. Corrective surgery was more likely when patients presented in a teaching hospital (27.8% vs 23.2%, p ⬍ 0.001), a trauma center (27.7% vs 22.2%, p ⫽ 0.0001), or a metropolitan hospital (29.9% vs 17.7%, p ⬍ 0.0001). Patients who presented with a PF in the Northeast were more likely to have surgery than those presenting in other parts of the country (Northeast 39.5%, Midwest 18.0%, South 21.4%, West 25.7%, p ⬍ 0.0001). There was a mild statistical difference in PF surgery favoring patients who presented during the weekend versus during the week (26.4% vs 23.1%, p ⫽ 0.007), but perhaps without clinical relevance. CONCLUSIONS: Given the assumption that the main factors driving corrective surgery for PF are time from injury and surgeon experience, it is striking to recognize the disparity in PF repair across demographic and socioeconomic parameters. Our study highlights the influence that hospital setting and patient insurance can have over treatment for PF and the need for a more focused analysis on patients presenting with this potentially correctable condition. Source of Funding: Havana Day Dreamers Foundation, SMSNA Fellowship Scholar 2012, SIU Urology Endowment Fund.
155 THE INCIDENCE OF VTE AND MAJOR BLEEDING EVENTS IN MAJOR UROLOGIC SURGERY: A POPULATION-BASED ANALYSIS Stephen Reese*, Aaron Lay, Jeffrey Leow, Daniel Welchons, Boston, MA; Benjamin Chung, Palo Alto, CA; Steven Chang, Boston, MA INTRODUCTION AND OBJECTIVES: Venous Thromboembolism (VTE), which comprises deep venous thrombosis (DVT) and pulmonary embolism (PE), represent a major burden on the United States healthcare system, with an increased risk for postoperative patients and patients with malignancy. The true incidence of VTE for major urologic surgery is poorly defined. We performed a populationbased analysis to determine the incidence of symptomatic VTEs, DVTs, PEs and major bleeding following major urologic surgery. We also identified independent predictors of predisposing risk factors for VTE and major bleeding events. METHODS: We captured all adult patients who underwent major urologic surgery between January 2003 and December 2010 based on 1CD-9-CM codes from the Perspective Database (Premier, Inc, Charlotte, NC), a nationally represented dataset capturing 20% of US hospital discharges. Major urologic surgery was defined as either a radical prostatectomy, radical cystectomy, radical nephrectomy or partial nephrectomy. We used ICD-9-CM codes to identify VTE and major bleeding after major urologic surgery. Univariate and multivariate analyses were performed by STATA after adjusting for sample weights. RESULTS: We captured n⫽922,559 total patients in our sample. Patients undergoing radical cystectomy had the highest rate of VTE (4.96%) and major bleeding (7.7%), while patients who underwent radical prostatectomy had the lowest rates of VTE (0.55%) and major bleeding (1.77%) (Table 1). Age over 70 was a significant risk factor for VTE (OR 6.10 p⬍0.001). Patients treated at teaching hospitals had a lower risk for VTE (0.85 p⬍0.001), but also had a higher risk for major bleeding (OR 1.06, p⬍0.001)(Fig. 1). CONCLUSIONS: Patients who had radical cystectomy had the highest incidence of VTE and major bleeding events. Higher utilization rates of peri-operative pharmacologic anticoagulation at teaching hospitals may be associated with a lower risk of VTE, but at the expense of higher risk of bleeding events.