Health Services Research| Volume 106, P76-81, August 2017

Trends in Operating Room Assistance for Major Urologic Surgical Procedures: An Increasing Role for Advanced Practice Providers


      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).


      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%.


      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.
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