Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 Urologist-Level Variation in the Management of Small Renal Masses J. Cheaib 1 ; H. Patel 1 ; M. Gupta 2 ; M. Biles 1 ; M. Metcalf 1 ; R. Alam 1 ; J. Canner 1 ; M. Johnson 1 ; M. Allaf 1 ; P. Pierorazio 1 1 Johns Hopkins Medicine, Baltimore, MD, USA; 2 New York University School of Medicine, New York City, NY, USA Introduction: Various approaches exist for managing small renal masses (SRM). Reporting urologist-level rates of eachmay be valuable to characterize unwarranted variation in the care of patients with SRM. Such data can also have significant implications for patient and payer stakeholder groups. Materials & Methods: We performed a population-based study of patients with SRM(cT1a tumors) from2004-2013 using the linked Surveillance, Epidemiology, and EndResults (SEER)-Medicare database. Management approachwas defined in SEER as nonsurgical management (NSM), thermal ablation (TA), partial nephrectomy (PN), or radical nephrectomy (RN). Patients were assigned to a primary urologist using Medicare physician specialty codes. Multivariable mixed-effects logistic models were fit to evaluate associations between management approaches and select patient characteristics; predicted probabilities of using each approach were then obtained for each urologist. Results: A total of 12738 patients with 2791 primary urologists were identified. Table 1 shows patient characteristics and predictors of eachmanagement approach. Likelihoods of undergoing NSM and PN were significantly associated with being diagnosed in 2009 and increased thereafter. At the individual urologist level, the estimated probability of NSM, TA, PN, and RN varied markedly: NSM (mean, 12.8%; range, 5.3-40.1%); TA (mean, 12.2%; range, 2.1-63.7%); PN (mean, 31.3%; range, 9.9-72.0%); RN (mean, 38.9%; range, 14.6-74.6%) (Figure 1). Conclusions: Considerable urologist-level variation exists in the management of SRM. An increase in NSM and PN was noted since the release of the first AUA guideline on clinical stage I renal mass in 2009. Our study establishes a framework for developing quality-improvement measures to improve the delivery of guideline- based care. MP4-08 Poster Session 4: Oncology Treatment and Outcomes 32