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Time Trends, Geographic Variation, and Outcomes

Grace L. Lu-Yao, PhD, MPH; Dale McLerran, MS; John Wasson, MD; John E. Wennberg, MD, MPH; Prostate Patient Outcomes Research Team; John E. Wennberg, MD, MPH; John H. Wasson, MD; Thomas Bubolz, PhD; Catherine C. Lindsay, SM; Benjamin Littenberg, MD; Ann B. Flood, PhD; Grace L. Lu-Yao, MPH, PhD; Chiang-Hua Chang, MS; Albert G. Mulley, MD; Michael J. Barry, MD; Christopher Coley, MD; Floyd J. Fowler, PhD; Reginald Bruskewitz, MD; Peter C. Albertson, MD; Craig Fleming, MD

JAMA. 1993;269(20):2633-2636.

Abstract
Objectives.
—To examine temporal trends and geographic variation in radical prostatectomy rates and short-term outcomes.

Design.
—Population-based study of radical prostatectomy for the years 1984 through 1990. Poisson regression was used to estimate temporal and regional effects.

Setting.
—The 50 states and the District of Columbia.

Participants.
—A 20% national sample of male Medicare beneficiaries aged 65 years or older.

Main Outcome Measures.
—Rate of radical prostatectomy; 30-day mortality; and major cardiopulmonary complications, vascular complications, or surgical repairs within 30 days of radical prostatectomy.

Results.
—A total of 10598 radical prostatectomies were identified. The adjusted rate of radical prostatectomy in 1990 was 5.75 times that in 1984. The relative increase was similar in all age groups. Substantial geographic variation existed in rates from 1988 through 1990: all states in the New England and Mid-Atlantic regions had rates equal to or below 60 per 100 000 male Medicare beneficiaries, while all states in the Pacific and Mountain regions had rates equal to or above 130 per 100 000. The mortality and morbidity after radical prostatectomy are not trivial for older men (aged 75 years and older)—almost 2% died and nearly 8% suffered major cardiopulmonary complications within 30 days of the operation.

Conclusion.
—The sharp increase and wide geographic variation in radical prostatectomy rates make the evaluation of this surgical procedure a pressing issue. The rising rate of radical prostatectomy among men aged 75 years and older merits special attention.

(JAMA. 1993;269:2633-2636)

Author Affiliations
Center for Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH; Massachusetts General Hospital, Boston; Center for Survey Research, University of Massachusetts at Boston; Clinical Science Center, University of Wisconsin, Madison; Health Science Center, University of Connecticut, Farmington; Biomedical Information and Communications Center, Oregon Health Sciences University, Portland

From the Center for Evaluative Clinical Sciences, Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH.

Footnotes
A complete list of the participants of the Prostate Patient Outcomes Research Team appears at the end of this article.

Reprint requests to Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, 206 Strasenburgh HB 7250, Hanover, NH 03755-3863 (Dr Wasson).

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Bibliography
Current Sociology 1998;46:128-144.
 

Survival After Radical Prostatectomy
Krongrad et al.
JAMA 1997;278:44-46.
ABSTRACT  

How do physicians diagnose dementia? Evidence from clinical vignette responses
Fortinsky and Wasson
AM J ALZHEIMERS DIS OTHER DEMEN 1997;12:51-61.
ABSTRACT  

Trends in Radical Prostatectomy in New York State
Imperato et al.
American Journal of Medical Quality 1996;11:205-213.
ABSTRACT  

Survival and Conservative Treatment for Localized Prostate Cancer-Reply
Albertsen
JAMA 1996;275:32-32.
ABSTRACT  

Long-term Survival Among Men With Conservatively Treated Localized Prostate Cancer
Albertsen et al.
JAMA 1995;274:626-631.
ABSTRACT  

Medicine--Molecular, Monetary, or More Than Both?
Eisenberg
JAMA 1995;274:331-334.
ABSTRACT  

Use of Prostate-Specific Antigen for Prostate Cancer Screening in Primary Care Practice
Williams et al.
Arch Fam Med 1995;4:311-315.
ABSTRACT  

Site-to-Site Variation in the Factors Affecting Cesarean Section Rates
Hueston
Arch Fam Med 1995;4:346-351.
ABSTRACT  

The Role of Increasing Detection in the Rising Incidence of Prostate Cancer
Potosky et al.
JAMA 1995;273:548-552.
ABSTRACT  

A Prospective Evaluation of Plasma Prostate-Specific Antigen for Detection of Prostatic Cancer
Gann et al.
JAMA 1995;273:289-294.
ABSTRACT  

Quality-of-Life Outcomes in Men Treated for Localized Prostate Cancer
Litwin et al.
JAMA 1995;273:129-135.
ABSTRACT  

Screening for Prostate Cancer: A Decision Analytic View
Krahn et al.
JAMA 1994;272:773-780.
ABSTRACT  

Increasing Incidence of Cancer of the Prostate: The Experience of Black and White Men in the Detroit Metropolitan Area
Demers et al.
Arch Intern Med 1994;154:1211-1216.
ABSTRACT  

Urology
Chodak
JAMA 1994;271:1717-1718.
ABSTRACT  

PSA and the Detection of Prostate Cancer
Robbins
JAMA 1994;271:192-192.
ABSTRACT  

Treatment Strategies for Prostate Cancer
Switzer
JAMA 1993;270:1692-1692.
ABSTRACT  

Treatment Strategies for Prostate Cancer
Cockett
JAMA 1993;270:1692-1693.
ABSTRACT  

Treatment Strategies for Prostate Cancer-Reply
Fleming
JAMA 1993;270:1693-1693.
ABSTRACT  

Serum Prostate-Specific Antigen in a Community-Based Population of Healthy Men: Establishment of Age-Specific Reference Ranges
Oesterling et al.
JAMA 1993;270:860-864.
ABSTRACT  

Radical Prostatectomy Is on the Rise, Despite Questions about Its Value
Journal Watch Dermatology 1993;1993:17-17.
FULL TEXT  

RADICAL PROSTATECTOMY IS INCREASING, DESPITE QUESTIONS ABOUT ITS VALUE
JWatch General 1993;1993:1-1.
FULL TEXT  

A Decision Analysis of Alternative Treatment Strategies for Clinically Localized Prostate Cancer
Fleming et al.
JAMA 1993;269:2650-2658.
ABSTRACT  

Management of Clinically Localized Prostatic Cancer: An Unresolved Problem
Whitmore
JAMA 1993;269:2676-2677.
ABSTRACT  

Inaugural Article: Immunoassays with rolling circle DNA amplification: A versatile platform for ultrasensitive antigen detection
Schweitzer et al.
Proc. Natl. Acad. Sci. USA 2000;97:10113-10119.
ABSTRACT | FULL TEXT