title: An evaluation of radical prostatectomy at Veterans Affairs Medical Centers: time trends and geographic variation in utilization and outcomes.
abstract: OBJECTIVE
  To examine temporal trends and geographic variation in utilization of radical prostatectomy (RP) as well as 30-day mortality and complication rates.
  
  
  METHODS
  Administrative data-base study of radical prostatectomy (RP) using the Department of Veterans Affairs Patient Treatment File and Outpatient Clinic File between 1986 to 1996. Logistic regression was used to estimate temporal and geographic effects on the use of RP.
  
  
  METHODS
  All Departments of Veterans Affairs Medical Centers (VAMC) in the contiguous United States.
  
  
  METHODS
  Men aged 45 to 84 years who underwent RP at a VAMC (n = 13,398).
  
  
  METHODS
  Number and utilization of RP, rate of 30-day mortality, major cardiopulmonary or vascular complications, and colorectal injuries requiring surgical repair within 30 days of RP.
  
  
  RESULTS
  From 1986 to 1996, the annual number of RP at VAMCs (range, 695-1,545 RP) more than doubled, and the rate of RP at VAMCs per male VA user increased by 40% (range, 48/100,000-66/100,000). After controlling for age and year, the utilization of RP in West North Central, Mountain, West South Central, and Pacific census divisions was 70%, 14%, 10%, and 8% higher, respectively, whereas the utilization of RP in New England, East North Central, and Mid-Atlantic divisions was 38%, 31%, and 25% lower, respectively, than the rest of the nation (P<0.001). Geographic variation in utilization decreased during the period between 1986 and 1996, but a twofold difference in RP utilization in 1996 remained between high- and low-utilization divisions. Major cardiopulmonary complications, vascular complications, and colorectal injuries occurred in 1.7%, 0.2%, and 1.8% of men, respectively. Thirty-day mortality was 0.73%, declined from 1986 to 1996, and was associated with a history of diabetes and congestive heart failure.
  
  
  CONCLUSIONS
  Utilization of RP at VAMCs increased over time and varied across geographic areas. Thirty-day mortality was less than 1% and decreased with time. Differences in utilization may be caused by uncertainty regarding the effectiveness of early detection and treatment of prostate cancer.
authors.affiliation: Section of General Internal Medicine and Minneapolis VA:VISN 13 Center for Chronic Disease Outcomes Research, MN 55417, USA. wilt.timothy@minneapolis.va.gov
authors.forename: T J
authors.initials: TJ
authors.lastname: Wilt
authors.forename: D C
authors.initials: DC
authors.lastname: Cowper
authors.forename: J K
authors.initials: JK
authors.lastname: Gammack
authors.forename: D R
authors.initials: DR
authors.lastname: Going
authors.forename: S
authors.initials: S
authors.lastname: Nugent
authors.forename: S J
authors.initials: SJ
authors.lastname: Borowsky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005069:Evaluation Studies as Topic; D017052:Hospital Mortality; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012041:Regional Medical Programs / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data