Login to Access Video or Poster Abstract: MP70-20
Sources of Funding: none

Introduction

With the increased incidence of low-risk prostate and renal cancer, minimally invasive treatment options have become more desirable. In selected patients, focal ablative therapies offer less morbidity while achieving comparable outcomes to extirpative surgery. We describe patterns of usage of such therapies within a statewide database.

Methods

We queried the New York Statewide Planning and Research Cooperative System database to identify patients who underwent any focal ablative treatment for prostate or renal malignancy from 2001-2014 using CPT codes (55873, 53852, 53850, 50593, 50250, 50592, 50542), ICD-9-CM procedure codes (5532-5535, 6096, 6097), and ICD-9-CM diagnosis codes (185, 189.0, 189.1, 198.0). Medical comorbidities are also available. Hospital specific characteristics were obtained using available information from the New York Department of Health and the American Hospital Association. High volume centers were defined as the five highest volume hospitals according to number of ablative procedures. Logistic regression was performed to determine independent predictors of utilization.

Results

The final cohort included 1872 prostate ablations and 989 renal ablations. The five highest volume prostate and renal ablation centers performed 1173 (62.7%) and 376 (38.0%) cases, respectively. Demographic information is displayed in Table 1. On multivariate analysis, treatment with prostate ablation was associated with black race (OR 0.27, 95%CI 0.19-0.39, p<0.001), increasing age (OR 0.98, 95%CI 0.967-0.998, p=0.03), teaching hospital status (OR 3.32, 95%CI 2.34-4.71, p<0.001), and number of beds (OR 1.002, 95%CI 1.001-1.002, p<0.001). For renal ablation, significant predictors on multivariate analysis were black race (OR 0.46, 95%CI 0.25-0.84, p=0.012), other non-white race (OR 0.48, 95%CI 0.29-0.79, p=0.004), number of beds (OR 1.001, 95%CI 1.000-1.001, p<0.001), and higher Elixhauser comorbidity index (OR 1.017, 95%CI 1.002-1.033, p=0.025).

Conclusions

In New York State, the use of ablative therapies is largely limited to academic institutions in urban areas, yet minority populations are significantly less likely to undergo such procedures. Future study should focus on identifying the barriers to treatment and what impact this might have on disease outcomes among different populations.

Funding

none