title: Patterns of performance of retroperitoneal lymph node dissections by American urologists: most retroperitoneal lymph node dissections in the United States are performed by low-volume surgeons.
abstract: OBJECTIVE
  To characterize the current patterns of retroperitoneal lymph node dissection (RPLND) performance among practicing US urologists.
  
  
  METHODS
  Six-month case log data of urologists certifying between 2003 and 2013 were obtained from the American Board of Urology. Cases specifying both an International Classification of Diseases, Ninth Revision code for testis cancer and a Current Procedural Terminology code for RPLND were analyzed for surgeon-specific variables.
  
  
  RESULTS
  Among 8545 certifying urologists, 290 (3.4% of all) urologists logged 553 RPLNDs in the case log system with 21 (3.6%) performed laparoscopically. Median number of RPLNDs logged annually was 1 (range, 1-59; interquartile range, 1-1) with 3 urologists performing 23% of all RPLNDs. Seventy-five percent of urologists logged a single RPLND. Urologists who logged 2 RPLNDs in a year were in the top 25% of performers with over half (52%) of all RPLNDs performed by urologists who logged 1 or 2 RPLND. On univariate regression analysis, oncology specialization (odds ratio, 5.1 [95% confidence interval, 2.2-11.6; P = .0001]) and non-private practice type (odds ratio, 2.8 [95% confidence interval, 1.1-7.1; P = .03]) were predictive of top 10% (≥ 3 cases) surgeon RPLND volume.
  
  
  CONCLUSIONS
  Despite the critical importance of the surgical quality for outcomes of patients with testis cancer, the majority of surgeons performing RPLND are certifying for the first time and log only 1 RPLND.
authors.affiliation: Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Flum
authors.affiliation: Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Laurie
authors.initials: L
authors.lastname: Bachrach
authors.affiliation: Division of Biostatistics, Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Borko D
authors.initials: BD
authors.lastname: Jovanovic
authors.affiliation: Division of Biostatistics, Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Irene B
authors.initials: IB
authors.lastname: Helenowski
authors.affiliation: Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Flury
authors.affiliation: Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL. Electronic address: joshua.meeks@northwestern.edu.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Meeks
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000592:standards* / Q000639:trends; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012044:Regression Analysis; D012187:Retroperitoneal Space; D018570:Risk Assessment; D066231:Surgeons / Q000706:statistics & numerical data; D016019:Survival Analysis; D013647:Task Performance and Analysis; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States; D013521:Urologic Surgical Procedures, Male / Q000592:standards* / Q000639:trends; D016526:Workload