title: Factors associated with the adoption of minimally invasive radical prostatectomy in the United States.
abstract: OBJECTIVE
  Minimally invasive radical prostatectomy has supplanted radical retropubic prostatectomy in popularity despite the absence of strong comparative effectiveness data demonstrating its superiority. We examined the influence of patient, surgeon and hospital characteristics on the use of minimally invasive radical prostatectomy vs radical retropubic prostatectomy.
  
  
  METHODS
  Using SEER (Surveillance, Epidemiology and End Results)-Medicare linked data we identified 11,732 men who underwent radical prostatectomy from 2003 to 2007. We assessed the contribution of patient, surgeon and hospital characteristics to the likelihood of undergoing minimally invasive radical prostatectomy vs radical retropubic prostatectomy using multilevel logistic regression mixed models.
  
  
  RESULTS
  Patient factors (36.7%) contributed most to the use of minimally invasive radical prostatectomy vs radical retropubic prostatectomy, followed by surgeon (19.1%) and hospital (11.8%) factors. Among patient specific factors Asian race (OR 1.86, 95% CI 1.27-2.72, p = 0.001), clinically organ confined tumors (OR 2.71, 95% CI 1.60-4.57, p <0.001) and obtaining a second opinion from a urologist (OR 3.41, 95% CI 2.67-4.37, p <0.001) were associated with the highest use of minimally invasive radical prostatectomy while lower income was associated with decreased use of minimally invasive radical prostatectomy. Among surgeon and hospital specific factors, higher surgeon volume (OR 1.022, 95% CI 1.015-1.028, p <0.001), surgeon age younger than 50 years (OR 2.68, 95% CI 1.69-4.24, p <0.001) and greater hospital bed size (OR 1.001, 95% CI 1.001-1.002, p <0.001) were associated with increased use of minimally invasive radical prostatectomy, while solo or 2 urologist practices were associated with decreased use of minimally invasive radical prostatectomy (OR 0.48, 95% CI 0.27-0.86, p = 0.013).
  
  
  CONCLUSIONS
  The adoption of minimally invasive radical prostatectomy vs radical retropubic prostatectomy is multifactorial, and associated with specific patient, surgeon and hospital related factors. Obtaining a second opinion from another urologist was the strongest factor associated with opting for minimally invasive radical prostatectomy.
authors: Division of Urologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: William D
authors: WD
authors: Ulmer
authors: Sandip M
authors: SM
authors: Prasad
authors: Keith J
authors: KJ
authors: Kowalczyk
authors: Xiangmei
authors: X
authors: Gu
authors: Christopher
authors: C
authors: Dodgion
authors: Stuart
authors: S
authors: Lipsitz
authors: Ganesh S
authors: GS
authors: Palapattu
authors: Toni K
authors: TK
authors: Choueiri
authors: Jim C
authors: JC
authors: Hu
mesh_terms: D000368:Aged; D006761:Hospitals; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D014481:United States