title: Variations in Preoperative Use of Bone Scan Among Medicare Beneficiaries Undergoing Radical Cystectomy.
abstract: OBJECTIVE
  To examine factors associated with bone scan use in patients undergoing radical cystectomy and to assess trends in use over time.
  
  
  METHODS
  Using Surveillance, Epidemiology, and End Results-Medicare data, we identified 5573 patients who underwent radical cystectomy from 2004 to 2011. The primary outcome was completion of a bone scan within 6 months prior to surgery. Demographic, regional, and clinicopathologic predictors of bone scan use were examined using a mixed logit model with health service area as a random effect.
  
  
  RESULTS
  Among radical cystectomy patients, 1754 (31%) completed a preoperative bone scan. Urologists ordered most of these studies (69%). The adjusted probability of a patient undergoing a bone scan decreased from 0.40 in 2004 to 0.29 in 2011 (P = .01). Compared with patients in the northeast region, those in the south, central, and west regions were less likely to have a bone scan (P <.001). Compared with those with stage ≤T1, patients with higher stage disease were more likely to have a bone scan (P <.001). Among the highest volume surgeons, there was significant variation in the proportion of patients who completed preoperative bone scans (P < .001).
  
  
  CONCLUSIONS
  Despite a recent decline, bone scans are used frequently in the preoperative staging of bladder cancer. Although some clinical factors are associated with bone scan use, significant regional and provider variation suggest areas to improve standardization of practice.
authors.affiliation: Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: turnerrm@upmc.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Turner
authors.affiliation: Division of Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Yabes
authors.affiliation: Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Davies
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA.
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.affiliation: Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000378:metabolism; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000473:pathology; D015331:Cohort Studies; D015653:Cystectomy; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D057234:Preoperative Period; D011336:Probability; D018426:SEER Program; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D014481:United States; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*
chemical_list: D000469:Alkaline Phosphatase