title: A comparison of case volumes among urologic surgeons identified on an industry-sponsored website to an all provider peer group.
abstract: BACKGROUND
  Industry-sponsored websites for robotic surgery direct to surgeons listed as performing specific robotic surgical procedures. The purpose of this study was to compare average annual, surgeon-specific, case volumes for those procedures for which they were listed as performing on the commercial website with the volumes of all providers performing these same procedures across a defined geographic region.
  
  
  METHODS
  A list of providers within the state of Wisconsin cited as performing specific urologic procedures was obtained through the Intuitive Surgical website 〈http://www.davincisurgery.com/da-vinci-urology/〉. Surgeon-specific annual case volumes from 2009 to 2013 for these same cases were obtained for all Wisconsin providers through DataBay Resources (Warrendale, PA) based on International classification of diseases-9 codes. Procedural activity was rank ordered, and surgeons were placed in "volume deciles" derived from the total annual number of cases performed by all surgeons. The distribution of commercially listed surgeon volumes, both 5-year average and most recent year, was compared with the average and 2013 volumes of all surgeons performing a specific procedure.
  
  
  RESULTS
  A total of 35 individual urologic surgeons listed as performing robotic surgery in Wisconsin were identified through a "search" using the Intuitive Surgical website. Specific procedure analysis returned 5, 12, 9, and 15 surgeon names for cystectomy, partial nephrectomy, radical nephrectomy, and prostatectomy, respectively. This compared with the total number of surgeons who had performed the listed procedure in Wisconsin at least 1 time during the prior 5 years of 123, 153, 242, and 165, respectively. When distributed by surgeon-volume deciles, surgeons listed on industry-sponsored sites varied widely in their respective volume decile. More than half of site-listed, procedure-specific surgeons fell below the fifth decile for surgeon volume. Data analysis based solely on 2013 case volumes had no effect on the number of website-listed surgeons whose volumes fell below the fifth decile.
  
  
  CONCLUSIONS
  Surgeons listed on an industry-sponsored website demonstrate wide variation in the actual volume of specific procedures performed. The inferred endorsement of competence by commercial sites has the potential to mislead patients seeking surgical expertise. Providers should consider the ethical and legal implications of these commercial advertising that do not have volume or outcome data.
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, WI; Froedtert Memorial Lutheran Hospital, Milwaukee, WI. Electronic address: wsee@mcw.edu.
authors.forename: William A
authors.initials: WA
authors.lastname: See
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, WI; Froedtert Memorial Lutheran Hospital, Milwaukee, WI.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jacobson
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, WI; Froedtert Memorial Lutheran Hospital, Milwaukee, WI.
authors.forename: Sue
authors.initials: S
authors.lastname: Derus
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, WI; Froedtert Memorial Lutheran Hospital, Milwaukee, WI.
authors.forename: Peter
authors.initials: P
authors.lastname: Langenstroer
mesh_terms: D006801:Humans; D020407:Internet; D010379:Peer Group; D065287:Robotic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D066231:Surgeons / Q000706:statistics & numerical data; D013520:Urologic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D014572:Urology / Q000706:statistics & numerical data*; D014922:Wisconsin
keywords: Case volumes; Commercial endorsement; Robotic surgery