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Journal

Patterns of Surveillance Imaging After Nephrectomy in the Medicare Population

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Published:25th Mar 2020

Objectives:

To characterize patterns of imaging surveillance after nephrectomy in a population-based cohort of older kidney cancer patients.

Patients and Methods:

Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified patients ≥66 years of age who had partial or radical nephrectomy for localized kidney cancer diagnosed between 2000 and 2009.

Primary outcomes were chest (X-ray or CT) and abdominal (CT, MRI or ultrasound) imaging in Medicare claims from 4 to 36 months after surgery.

We estimated the frequency of imaging in three time periods (post-operative months 4-12, 13-24, 25-36), stratified by tumor stage.

Repeated-measures logistic regression was used to identify patient and disease characteristics associated with imaging.

Results:

Rates of chest imaging were 65-80%, with chest X-ray surpassing CT in each time period.

Rates of abdominal imaging were 58-76%, and cross-sectional imaging was more common than ultrasound in each time period.

Use of cross-sectional chest and abdominal imaging increased over time while chest X-ray decreased (p<0.01). Ultrasound use remained stable for T1 and T2 patients, but decreased in patients with for T3 patients disease (p<0.05).

Rates of chest and abdominal imaging increased with tumor stage (p<0.0001).

Conclusions:

Patterns of imaging suggest possible overuse in patients at low risk of recurrence and underuse in those at greater risk.

New surveillance imaging guidelines may reduce unwarranted variability and promote risk-based, cost-effective management after nephrectomy.

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