William Meeks

The Near-future Impact of Retirement on the Urologic Workforce: Results From the American Urological Association Census

OBJECTIVE To assess self-perceived planned retirement patterns among urologists by using the American Urological Association Census Data. With an expanding elderly population and an aging urologic workforce, concerns regarding increased demand and decreased supply of urologists have been raised. MATERIALS AND METHODS We analyzed data from the 2014 American Urological Association Census, which is a specialty representative survey distributed to the urologists who practice in the United States. A total of 2204 census samples were weighted to represent 11,703 urologists who practiced in the United States in 2014. We compared urologists who are nearing retirement (within 5 years of their planned retirement) with the rest of urologists on their demographic, geographic, and practice characteristics. RESULTS Of the 11,703 practicing urologists in the United States, 3181 (95% confidence interval: 2884-3479) or 27% (95% confidence interval: 25%-30%) are nearing planned retirement. The mean age (standard deviation [SD]) of urologists nearing retirement (69, SD = 8.2) was older than nonretiring urologists (48, SD = 10.3), P < .01. Nearly double the proportion of nearing retirement urologists is found in nonmetropolitan compared to nonretiring urologists, 534 (17%) vs 782 (9%), P < .01, respectively. Urologists nearing retirement are more likely to practice general urology compared to nonretiring urologists, 2341 (74%) vs 5072 (60%), P < .01. Among urologists nearing retirement, 2155 (68%) of them still perform inpatient operations. CONCLUSION More than one-fourth of existing practicing urologists plan to retire in the next 5 years. General urology and urology practices outside of metropolitan areas will be impacted the most by the planned retiring workforce.

Burnout in Urology - Findings from the 2016 AUA Annual Census

Introduction: Physician burnout is linked to decreased job performance, increased medical errors, interpersonal conflicts and depression. Two recent multispecialty studies showed that urologists had the highest rate of burnout. However, these reports were limited by a low sample size of urologists (119). We aimed to establish the prevalence of urologist burnout and associated factors. Methods: In the 2016 American Urological Association Census, Maslach Burnout Inventory questions were randomly assigned to half of the respondents. Using matrix sampling, the 1,126 practicing urologists who received and answered the Maslach Burnout Inventory questions represented the entire 2,301 who completed the census. Burnout was defined as scoring high on the scales of emotional exhaustion or depersonalization. Demographic and practice variables were assessed to establish factors correlating to burnout. Results: Overall 38.8% of urologists met the criteria for burnout, with 17.2% scoring high for emotional exhaustion and 37.1% scoring high for depersonalization. Multivariate analysis revealed that urologist burnout is associated with more patient visits per week, younger age, being in a subspecialty area other than pediatric or oncology, in solo or multispecialty practice, practice size greater than 2 and greater number of work hours per week. Conclusions: These results suggest that the burnout rate for urologists is lower than previously reported, and are consistent with rates reported in other medical and surgical specialties. However, burnout continues to be an important issue. Greater workload correlated with increased burnout while other practice patterns appeared to be protective. It is critical to keep urologists in the workforce to help lessen projected shortages.

MP96-14 ANALYSIS OF NATIONAL TRENDS IN HOSPITAL ACQUIRED CONDITIONS FOLLOWING MAJOR UROLOGIC SURGERY BEFORE AND AFTER IMPLEMENTATION OF THE HOSPITAL ACQUIRED CONDITION REDUCTION PROGRAM

Objective To define the rates of common hospital acquired conditions (HACs) in patients undergoing major urologic surgery over a period of time encompassing the implementation of the Hospital Acquired Condition Reduction program, and to evaluate whether implementation of the HAC reimbursement penalties in 2008 was associated with a change in the rate of HACs. Methods Using American College of Surgeons National Surgical Quality Improvement Program data, we determined rates of HACs in patients undergoing major inpatient urologic surgery from 2005 to 2012. Rates were stratified by procedure type and approach (open vs laparoscopic and/or robotic). Multivariable logistic regression was used to determine the association between year of surgery and HACs. Results We identified 39,257 patients undergoing major urologic surgery, of whom 2300 (5.9%) had at least one hospital acquired condition. Urinary tract infection (2.6%) was the most common, followed by surgical site infection (2.5%) and venous thrombotic events (0.7%). Multivariable logistic regression analysis demonstrated that open surgical approach, diabetes, congestive heart failure, chronic obstructive pulmonary disease, weight loss, and American Society of Anesthesiology class were among the variables associated with higher likelihood of HAC. We observed a nonsignificant secular trend of decreasing rates of HAC from 7.4% to 5.8% HACs during the study period, which encompassed the implementation of the Hospital Acquired Condition Reduction program. Conclusion HACs occurred at a rate of 5.9% after major urologic surgery, and are significantly affected by procedure type and patient health status. The rate of HAC appeared unaffected by National Reduction program in this cohort. Better understanding of the factors associated with HACs is critical in developing effective reduction programs.

MP76-10 BURNOUT IN UROLOGY: RESULTS FROM THE 2016 AUA CENSUS

INTRODUCTION AND OBJECTIVES: Few large series in the literature examine predictors of metastatic disease at time of testicular cancer diagnosis. We performed an analysis of the National Cancer Database (NCDB) to examine predictors of metastatic disease at the time of diagnosis and overall survival (OS) based on site of metastatic disease. METHODS: Utilizing the NCDB, 44,354 patients were identified with data available for metastatic disease at time of diagnosis and tumor histology. Metastases were stratified as either absent, lymph node only, lung, brain, liver or bone metastases. Demographic characteristics, socioeconomic indicators and tumor histology were compared using the chi-squared test. Univariate survival analysis was performed using the Kaplan Meier method. Multivariate survival analysis was performed using cox proportional hazard model. RESULTS: Mean age of diagnosis was 35 and mean follow-up was 53 months. On univariate analysis decreased age at diagnosis (p<0.001), non-white race (p1⁄40.002), uninsured status (p1⁄4<0.001), <

MP2-18 DEVELOPMENT AND IMPLEMENTATION OF A VALIDATED ELECTRONIC MEDICAL RECORD EXTRACTION PROCESS TO DETERMINE ADHERENCE WITH THE AUA CLINICAL PRACTICE GUIDELINES ON LUTS/BPH

38,000 annual income (p1⁄4<0.001), distance from treating hospital (p<0.001), and pure choriocarcinoma histology (166/202, 82%, p<0.001) were associated with metastases at time of diagnosis. 3,504 (7.9%) patients had metastatic disease at diagnosis. Kaplan Meier survival analysis showed significant differences in OS between metastatic sites at presentation, with 5 yr OS of 87% for lymph node only metastases compared to 48% OS in those with brain metastases (p<0.001). On multivariate analysis while controlling for age, race, insurance status, income, comorbidities, histology, receipt of chemotherapy, and primary tumor size, metastases to any site were associated with worsened survival compared to no metastases (referent): metastasis to lymph nodes (3.4, 95% CI: 2.70-4.50, p<0.001), lung (4.48, 95% CI: 3.69-5.43, p<0.001), liver (10.32, 95% CI: 6.78-15.7), bone (12.99, 95% CI: 7.93-21.29) and brain (14.4, 95% CI: 9.53-21.89). Private insurance status (0.48, 95% CI: 0.40-0.56, p<0.001) and income >

An Observational Analysis of Provider Adherence to AUA Guidelines on the Management of Benign Prostatic Hyperplasia

63,000 (0.72, 95% CI: 0.60-0.87, p1⁄40.001) were favorable predictors of OS. CONCLUSIONS: There are significant differences in OS dependent on site of metastases at time of testicular cancer diagnosis. Several sociodemographic factors likely contribute to likelihood of metastases at presentation as well. Further prospective studies are warranted to better characterize the impact of sociodemographic factors on metastases at presentation and to improve access to care in high-risk populations.

MP67-12 PEYRONIE'S DISEASE IS ASSOCIATED WITH INCREASED IMMUNE REACTIVITY: ANALYSIS OF UNITED STATES CLAIMS DATA

INTRODUCTION AND OBJECTIVES: The validated Interstitial Cystitis Symptom and Problem Index (ICSI-PI) reliably measures symptoms and associated bother in patients with interstitial cystitis. We evaluated whether the ICSI-PI reliably measures overactive bladder (OAB) symptoms in patients with OAB with/without incontinence (OAB wet/dry). METHODS: Adults in our prospective observational neuromodulation study were evaluated. Inclusion criteria were OAB wet/dry and staged lead and generator implant. Subjects completed the ICSI-PI and Overactive Bladder Questionnaire-short form (OAB-q) at baseline and 3, 6, and 12 months post implant. The ICSI-PI is comprised of a symptom index (IC-SI) and bother index (IC-PI) which assess voiding symptoms and pain. The OAB-q contains symptom severity (SS) and health related quality of life (HRQOL) scales. Descriptive statistics were performed for sample characteristics. At each time point, IC-SI and OAB-q SS responses, and IC-PI and OAB-q HRQOL responses were compared with Spearman’s Correlations in patients that completed both measures. RESULTS: Of 215 patients (mean age 65.1 14.2 years), 80% were female, 94% were caucasian, 67.4% had attended at least some college, 24.5% had an income >

LBA1 CHARACTERISTICS OF PARTICIPANTS IN THE AUA QUALITY (AQUA) REGISTRY AND EARLY IMPACT OF PARTICIPATION ON QUALITY OF CARE

70,000/year, and 84% had OAB wet. As shown in the table below, at each time point there was a strong correlation between IC-SI and OAB-q SS scores. Additionally, IC-PI and OAB-q QOL scores were strongly negatively correlated indicating that higher symptom bother negatively impacted HRQOL. CONCLUSIONS: Even though pain is not a component of the OAB syndrome, the ICSI-PI appears to reliably measure voiding symptoms and bother in patients with OAB.