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OR Assistance for Major Urologic Surgical Procedures: An Increasing Role for Advanced Practice Providers
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersOBJECTIVE
To characterize changes in surgical assistance patterns over time for commonly performed urologic operations.
MATERIALS AND METHODS
This study used the Medicare Physician/Supplier Procedure Summary Master File to identify cases performed by urologists from 2003 to 2014. Current Procedural Terminology modifiers were used to identify operations assisted by second surgeons and advanced practice providers (APPs). Rates were reported annually for 6 common urologic operations, and average annual rates of change were determined using least squares regression and tested using t tests (α = .05).
RESULTS
Of the urologic operations analyzed, 5.0% of cases (n = 33,895) were assisted by APPs compared with 27.0% (n = 182,842) assisted by a second surgeon. The proportion of cases assisted by an APP rose significantly for all procedures; conversely, the proportion of cases assisted by a second surgeon declined significantly for all procedures, except for open partial nephrectomy. The largest changes were seen in robotic prostatectomies for which second surgeon assistance fell from 26% in 2004 to 15% in 2014, whereas APP assistance rose from <1% to 7%.
CONCLUSION
Urologists are increasingly using APPs as assistants in surgery, particularly in robotic and laparoscopic operations. This trend will likely continue as the shortage of urologists worsens in the coming years.
Additional Info
Disclosure statements are available on the authors' profiles:
Trends in Operating Room Assistance for Major Urologic Procedures: An Increasing Role for Advanced Practice Providers
Urology 2017 Aug 01;106(xx)76-81, AR Swanton, AN Alzubaidi, Y Han, KG Nepple, BA EricksonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The 2017 Urology publications by Swanton et al. and Langston et al. provide the documentation for the well recognized and ever-expanding role for advanced practice providers (APPs). This provider disruptive change has numerous contributing factors, including marked expansion of the US population in conjunction with disproportionate increase in the US geriatric population, aka, the silver tsunami; the manpower shortage of US-trained urologists and the disproportionate aging of the US urologist; the declining payor reimbursement pressures for surgical skills; the excessive and burdensome regulatory healthcare coding demands limiting direct physician-patient communication and interaction; patient accessibility issues; and physician burnout contagion. Clearly, the option for less expensive healthcare providers will fulfill the vacuum created by all of the above issues. APPs will not only increase their percentage of involvement for surgical procedures, inpatient and outpatient, but also they will continue to play a burgeoning role for providing care for new patient visits, established care patients, specialty clinic development, call coverage, and more. Our educational leadership, associations, and payors will need a vigilant multidisciplinary approach to ensure that the quality of care for the American public is neither diminished nor compromised.