High regional variation in prostate surgery for benign prostatic hyperplasia in Switzerland
Among various treatment options for benign prostatic hyperplasia (BPH), surgical therapy is the most invasive. As Switzerland has the highest transurethral prostatectomy rate among OECD countries, we assessed the regional variation in prostate surgery for BPH and explored potential determinants of v...
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| description | Among various treatment options for benign prostatic hyperplasia (BPH), surgical therapy is the most invasive. As Switzerland has the highest transurethral prostatectomy rate among OECD countries, we assessed the regional variation in prostate surgery for BPH and explored potential determinants of variation. We conducted a population-based analysis using discharge data for men aged [greater than or equal to]40 years with transurethral or simple prostatectomy from all Swiss hospitals during 2013-2018. After excluding patients with genitourinary/prostate cancer, we derived hospital service areas (HSAs) by analyzing patient flows. We calculated age-standardized mean procedure rates and variation indices (extremal quotient [EQ] and systematic component of variation [SCV]). We estimated the reduction in variance across HSAs of prostatectomy rates in multilevel regression models, with incremental adjustment for age, regional cultural and socioeconomic factors, disease burden, density of urologists, and the time since urologists' graduation. Overall, 44,253 prostatectomies (42,710 transurethral and 1543 simple) from 44 HSAs were analyzed. The mean age-standardized prostate surgery rate was 314 (range 166-500) per 100,000 men aged [greater than or equal to]40 years per year. The EQ was 3.01 and the SCV 5.53, indicating a high regional variation. In multivariate models, men aged 75-79 years had an 11.6-fold higher prostatectomy rate than those aged 50-54 years. French/Italian language areas had a 21% lower rate than Swiss German speaking areas. Socioeconomic factors, disease burden, and density of urologist/time since graduation were not associated with prostatectomy rates. After full adjustment, 80% of the variance in prostate surgery across HSAs remained unexplained. We found a remarkably high regional variation in prostate surgery rates for BPH within Switzerland. |
| doi_str_mv | 10.1371/journal.pone.0254143 |
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As Switzerland has the highest transurethral prostatectomy rate among OECD countries, we assessed the regional variation in prostate surgery for BPH and explored potential determinants of variation. We conducted a population-based analysis using discharge data for men aged [greater than or equal to]40 years with transurethral or simple prostatectomy from all Swiss hospitals during 2013-2018. After excluding patients with genitourinary/prostate cancer, we derived hospital service areas (HSAs) by analyzing patient flows. We calculated age-standardized mean procedure rates and variation indices (extremal quotient [EQ] and systematic component of variation [SCV]). We estimated the reduction in variance across HSAs of prostatectomy rates in multilevel regression models, with incremental adjustment for age, regional cultural and socioeconomic factors, disease burden, density of urologists, and the time since urologists' graduation. Overall, 44,253 prostatectomies (42,710 transurethral and 1543 simple) from 44 HSAs were analyzed. The mean age-standardized prostate surgery rate was 314 (range 166-500) per 100,000 men aged [greater than or equal to]40 years per year. The EQ was 3.01 and the SCV 5.53, indicating a high regional variation. In multivariate models, men aged 75-79 years had an 11.6-fold higher prostatectomy rate than those aged 50-54 years. French/Italian language areas had a 21% lower rate than Swiss German speaking areas. Socioeconomic factors, disease burden, and density of urologist/time since graduation were not associated with prostatectomy rates. After full adjustment, 80% of the variance in prostate surgery across HSAs remained unexplained. 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As Switzerland has the highest transurethral prostatectomy rate among OECD countries, we assessed the regional variation in prostate surgery for BPH and explored potential determinants of variation. We conducted a population-based analysis using discharge data for men aged [greater than or equal to]40 years with transurethral or simple prostatectomy from all Swiss hospitals during 2013-2018. After excluding patients with genitourinary/prostate cancer, we derived hospital service areas (HSAs) by analyzing patient flows. We calculated age-standardized mean procedure rates and variation indices (extremal quotient [EQ] and systematic component of variation [SCV]). We estimated the reduction in variance across HSAs of prostatectomy rates in multilevel regression models, with incremental adjustment for age, regional cultural and socioeconomic factors, disease burden, density of urologists, and the time since urologists' graduation. Overall, 44,253 prostatectomies (42,710 transurethral and 1543 simple) from 44 HSAs were analyzed. The mean age-standardized prostate surgery rate was 314 (range 166-500) per 100,000 men aged [greater than or equal to]40 years per year. The EQ was 3.01 and the SCV 5.53, indicating a high regional variation. In multivariate models, men aged 75-79 years had an 11.6-fold higher prostatectomy rate than those aged 50-54 years. French/Italian language areas had a 21% lower rate than Swiss German speaking areas. Socioeconomic factors, disease burden, and density of urologist/time since graduation were not associated with prostatectomy rates. After full adjustment, 80% of the variance in prostate surgery across HSAs remained unexplained. We found a remarkably high regional variation in prostate surgery rates for BPH within Switzerland.</description><subject>Age</subject><subject>Biology and Life Sciences</subject><subject>Cancer surgery</subject><subject>Complications and side effects</subject><subject>Density</subject><subject>Genital diseases</subject><subject>Hospitals</subject><subject>Hyperplasia</subject><subject>Hypertrophy</subject><subject>Internal medicine</subject><subject>Invasiveness</subject><subject>Italian language</subject><subject>Mathematical analysis</subject><subject>Medicine and Health Sciences</subject><subject>Patient outcomes</subject><subject>Patient satisfaction</subject><subject>Patients</subject><subject>People and Places</subject><subject>Population</subject><subject>Preventive medicine</subject><subject>Primary care</subject><subject>Prostate</subject><subject>Prostate cancer</subject><subject>Prostatectomy</subject><subject>Quotients</subject><subject>Regional 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Radoslaw</au><au>Chiolero, Arnaud</au><au>Rodondi, Nicolas</au><au>Aujesky, Drahomir</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High regional variation in prostate surgery for benign prostatic hyperplasia in Switzerland</atitle><jtitle>PloS one</jtitle><date>2021-07-22</date><risdate>2021</risdate><volume>16</volume><issue>7</issue><spage>e0254143</spage><epage>e0254143</epage><pages>e0254143-e0254143</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Among various treatment options for benign prostatic hyperplasia (BPH), surgical therapy is the most invasive. As Switzerland has the highest transurethral prostatectomy rate among OECD countries, we assessed the regional variation in prostate surgery for BPH and explored potential determinants of variation. We conducted a population-based analysis using discharge data for men aged [greater than or equal to]40 years with transurethral or simple prostatectomy from all Swiss hospitals during 2013-2018. After excluding patients with genitourinary/prostate cancer, we derived hospital service areas (HSAs) by analyzing patient flows. We calculated age-standardized mean procedure rates and variation indices (extremal quotient [EQ] and systematic component of variation [SCV]). We estimated the reduction in variance across HSAs of prostatectomy rates in multilevel regression models, with incremental adjustment for age, regional cultural and socioeconomic factors, disease burden, density of urologists, and the time since urologists' graduation. Overall, 44,253 prostatectomies (42,710 transurethral and 1543 simple) from 44 HSAs were analyzed. The mean age-standardized prostate surgery rate was 314 (range 166-500) per 100,000 men aged [greater than or equal to]40 years per year. The EQ was 3.01 and the SCV 5.53, indicating a high regional variation. In multivariate models, men aged 75-79 years had an 11.6-fold higher prostatectomy rate than those aged 50-54 years. French/Italian language areas had a 21% lower rate than Swiss German speaking areas. Socioeconomic factors, disease burden, and density of urologist/time since graduation were not associated with prostatectomy rates. After full adjustment, 80% of the variance in prostate surgery across HSAs remained unexplained. We found a remarkably high regional variation in prostate surgery rates for BPH within Switzerland.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>34292959</pmid><doi>10.1371/journal.pone.0254143</doi><tpages>e0254143</tpages><orcidid>https://orcid.org/0000-0001-6347-0198</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Age Biology and Life Sciences Cancer surgery Complications and side effects Density Genital diseases Hospitals Hyperplasia Hypertrophy Internal medicine Invasiveness Italian language Mathematical analysis Medicine and Health Sciences Patient outcomes Patient satisfaction Patients People and Places Population Preventive medicine Primary care Prostate Prostate cancer Prostatectomy Quotients Regional analysis Regions Regression analysis Regression models Service areas Social factors Social Sciences Socioeconomic data Socioeconomic factors Socioeconomics Surgery Urinary retention Urogenital system Urological surgery Urology Variation |
| title | High regional variation in prostate surgery for benign prostatic hyperplasia in Switzerland |
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