Skip to main content
Log in

Physician preference is a major factor in management of vesicoureteral reflux

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Known factors affecting the management of vesicoureteral reflux (VUR) include reflux grade, infection frequency, age and gender. We hypothesized that provider preference is highly associated with management.

Methods

Utilizing the national billing database, Faculty Practice Solutions Center, a multivariable logistic regression model, was applied to analyze the association of pediatric urologist treatment patterns, patient age, gender, uni- or bilateral disease, insurance type, presence of nephropathy and race with the type of VUR treatment a patient would receive.

Results

We identified 59 pediatric urologists who managed 7,882 new reflux patients from 2009 to 2011. Over this 3-year period there was wide variation in surgical utilization between surgeons (mean 50 %) but minimal change for each surgeon (5 %). For every 100 new reflux patients, median utilization of reimplantation surgery and injection of dextranomer/hyaluronic acid copolymer (Deflux) was 26 and 20 %, respectively. Age ranked highest in predicting surgical versus non-surgical management, while a surgeon’s historic Deflux utilization rate ranked highest in predicting surgery type. Older age, female gender and white race also increased the odds of Deflux utilization over reimplantation.

Conclusions

A surgeon’s historic Deflux utilization was the most important predictor of VUR surgery type. Although data on reflux grade were not available, analysis of patient and surgeon characteristics suggests that surgeon preference is the first or second most critical factor in determining a patient’s treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lendvay TS, Sorensen M, Cowan CA, Joyner BD, Mitchell MM, Grady RW (2006) The evolution of vesicoureteral reflux management in the era of dextranomer/hyaluronic acid copolymer: a pediatric health information system database study. J Urol 176:1864–1867

    Article  CAS  PubMed  Google Scholar 

  2. Pollack CEWG, Bekelman J, Liao KJ, Armstrong K (2012) Physician social networks and variation in prostate cancer treatment in three cities. Health Serv Res 47:380–403

    Article  PubMed Central  PubMed  Google Scholar 

  3. Poon SA, Silberstein JL, Savage C, Maschino AC, Lowrance WT, Sandhu JS (2012) Surgical practice patterns for male urinary incontinence: analysis of case logs from certifying American urologists. J Urol 188:205–210

    Article  PubMed Central  PubMed  Google Scholar 

  4. Lane BRGS, Eggener S, Tobert CM, Kahnoski RJ, Kutikov A, Smaldone M, Whelan CM, Shalhav A, Uzzo RG (2014) Differential use of partial nephrectomy for intermediate and high complexity tumors may explain variability in reported utilization rates. J Urol 189:2047–2053

    Article  Google Scholar 

  5. Silberstein JL, Poon SA, Maschino AC, Lowrance WT, Garg T, Herr HW, Machele Donat S, Dalbagni G, Bochner BH, Sandhu JS (2013) Urinary diversion practice patterns among certifying American urologists. J Urol 189:1042–1047

    Article  PubMed Central  PubMed  Google Scholar 

  6. Akaike H (1974) A new look at the statistical model identification. IEEE Trans Autom Control Vol 19:716–723

    Article  Google Scholar 

  7. Kruskal W (1987) Relative importance by averaging over orderings. Am Stat 41:6–10

    Google Scholar 

  8. McCullagh P, Nelder JA (1989) Generalized linear models, 2nd edn. Chapman & Hall/CRC, Boca Raton

  9. Kruskal W (1989) Concepts of relative importance in recent scientific literature. Am Stat 43:2–6

    Google Scholar 

  10. Ferrer FA, McKenna PH, Hochman HI, Herndon A (1998) Results of a vesicoureteral reflux practice pattern survey among American academy of pediatrics, section on pediatric urology members. J Urol 160:1031–1037

    Article  CAS  PubMed  Google Scholar 

  11. Routh JC, Nelson CP, Graham DA, Lieu TA (2010) Variation in surgical management of vesicoureteral reflux: influence of hospital and patient factors. Pediatrics 125:e446–451

    Article  PubMed  Google Scholar 

  12. Szymanski KM, Oliveira LM, Silva A, Retik AB, Nguyen HT (2011) Analysis of indications for ureteral reimplantation in 3738 children with vesicoureteral reflux: a single institutional cohort. J Pediatr Urol 7:601–610

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

UHC-AAMC Faculty Practice Solutions Center and David Troland, Manager-Physician Services Analytics, as well as Ayan Patel, UC Davis Clinical and Translational Science Center, provided assistance with data acquisition and management.

Funding source

The project was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, #UL1 TR000002.

Financial disclosure

None.

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eric A. Kurzrock.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, O.T., Durbin-Johnson, B. & Kurzrock, E.A. Physician preference is a major factor in management of vesicoureteral reflux. Pediatr Nephrol 30, 131–138 (2015). https://doi.org/10.1007/s00467-014-2906-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-014-2906-4

Keywords

Navigation