Deborah Kaye

Positions:

Assistant Professor of Surgery

Surgery, Urology
School of Medicine

Member in the Duke Clinical Research Institute

Duke Clinical Research Institute
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.A. 2002

Washington University in St. Louis

M.D. 2010

Medical College of Wisconsin

M.S. 2017

University of Michigan at Ann Arbor

Fellow, Clinical Research Training Program

National Institutes of Health

General Surgery Intern, Surgery

Johns Hopkins Medicine

Urology Resident

Johns Hopkins Medicine

Fellow, Society of Urologic Oncology, Urology

University of Michigan at Ann Arbor

Publications:

Understanding the Costs Associated With Surgical Care Delivery in the Medicare Population.

BACKGROUND: Surgical care has been largely untargeted by Medicare payment reforms because episode costs associated with its delivery are not currently well understood. OBJECTIVE: To quantify the costs of inpatient and outpatient surgery in the Medicare population. METHODS: We analyzed claims data from a 20% national sample of Medicare beneficiaries (2008-2014). For a given study year, we identified all inpatient and outpatient procedures and constructed claims windows around them to define surgical episodes. After summing payments for services rendered during each episode, we totaled all inpatient and outpatient episode payments by surgical specialty. For inpatient episodes, we determined component payments related to the index hospitalization, readmissions, physician services, and postacute care. For outpatient episodes, we differentiated by the site of care (hospital outpatient department versus physician office versus ambulatory surgery center). We used linear regression to evaluate temporal trends in inpatient and outpatient surgical spending. Finally, we estimated the contribution of surgical care to overall Medicare expenditures. RESULTS: Total Medicare payments for surgical care are substantial, representing 51% of Program spending in 2014. They declined modestly over the study period, from $133.1 billion in 2008 to $124.9 billion in 2014 (-6.2%, P = 0.085 for the temporal trend). While spending on inpatient surgery contributed the most to total surgical payments (69.4% in 2014), it declined over the study period, driven by decreases in index hospitalization (-16.7%, P = 0.002) and readmissions payments (-27.0%, P = 0.003). In contrast, spending on outpatient surgery increased by $8.5 billion (28.7%, P < 0.001). This increase was realized across all sites of care (hospital outpatient department: 36.6%, P < 0.001; physician office: 22.1%, P < 0.001; ambulatory surgery center: 36.6%, P < 0.001). Ophthalmology and hand surgery witnessed the greatest growth in surgical spending over the study period. CONCLUSIONS AND RELEVANCE: Surgical care accounts for half of all Medicare spending. Our findings not only highlight the magnitude of spending on surgery, but also the areas of greatest growth, which could be targeted by future payment reforms.
Authors
Kaye, DR; Luckenbaugh, AN; Oerline, M; Hollenbeck, BK; Herrel, LA; Dimick, JB; Hollingsworth, JM
MLA Citation
Kaye, Deborah R., et al. “Understanding the Costs Associated With Surgical Care Delivery in the Medicare Population..” Ann Surg, vol. 271, no. 1, Jan. 2020, pp. 23–28. Pubmed, doi:10.1097/SLA.0000000000003165.
URI
https://scholars.duke.edu/individual/pub1426593
PMID
30601252
Source
pubmed
Published In
Ann Surg
Volume
271
Published Date
Start Page
23
End Page
28
DOI
10.1097/SLA.0000000000003165

Robotic surgery in urological oncology: patient care or market share?

Surgical robotic use has grown exponentially in spite of limited or uncertain benefits and large costs. In certain situations, adoption of robotic technology provides value to patients and society. In other cases, however, the robot provides little or no increase in surgical quality, with increased expense, and, therefore, does not add value to health care. The surgical robot is expensive to purchase, maintain and operate, and can contribute to increased consumerism in relation to surgical procedures, and increased reliance on the technology, thus driving future increases in health-care expenditure. Given the current need for budget constraints, the cost-effectiveness of specific procedures must be evaluated. The surgical robot should be used when cost-effective, but traditional open and laparoscopic techniques also need to be continually fostered.
Authors
Kaye, DR; Mullins, JK; Carter, HB; Bivalacqua, TJ
MLA Citation
Kaye, Deborah R., et al. “Robotic surgery in urological oncology: patient care or market share?.” Nat Rev Urol, vol. 12, no. 1, Jan. 2015, pp. 55–60. Pubmed, doi:10.1038/nrurol.2014.339.
URI
https://scholars.duke.edu/individual/pub1426602
PMID
25535000
Source
pubmed
Published In
Nat Rev Urol
Volume
12
Published Date
Start Page
55
End Page
60
DOI
10.1038/nrurol.2014.339

Confirmatory Magnetic Resonance Imaging with or without Biopsy Impacts Decision Making in Newly Diagnosed Favorable Risk Prostate Cancer.

PURPOSE: We investigated how magnetic resonance imaging and post-magnetic resonance imaging biopsy impact decision making in men considering active surveillance. MATERIALS AND METHODS: We reviewed the records of men in the Michigan Urological Surgery Improvement Collaborative with newly diagnosed favorable risk prostate cancer. Following diagnostic biopsy the men were classified into 3 groups, including group 1-no magnetic resonance imaging, group 2-magnetic resonance imaging only and group 3-magnetic resonance imaging/post-magnetic resonance imaging biopsy. For the purposes of counseling and shared decision making magnetic resonance imaging results were deemed reassuring (PI-RADS™ [Prostate Imaging Reporting and Data System] 3 or less) or nonreassuring (PI-RADS 4 or greater). Similarly, if the diagnostic biopsy was GG (Grade Group) 1, post-magnetic resonance imaging biopsy results were deemed nonreassuring if there was any amount of GG 2 or greater. If the diagnostic biopsy was GG 2, post-magnetic resonance imaging biopsy results were deemed nonreassuring if more than 3 cores were GG 2, or there was more than 50% GG 2 in any individual core or any volume of GG 3 or greater. RESULTS: Of 1,461 men with favorable risk prostate cancer 1,223 (84%) did not undergo magnetic resonance imaging, 157 (11%) underwent magnetic resonance imaging alone and 81 (6%) underwent magnetic resonance imaging and post-magnetic resonance imaging biopsy. Of the men who underwent magnetic resonance imaging alone more with reassuring findings elected active surveillance than men with nonreassuring or magnetic resonance imaging findings (74% vs 35% and 42%, respectively). The highest rate of active surveillance was noted in men with reassuring post-magnetic resonance imaging biopsy regardless of whether magnetic resonance imaging was reassuring or nonreassuring (93% and 96%, respectively). CONCLUSIONS: Magnetic resonance imaging and post-magnetic resonance imaging biopsy drive decision making in men with newly diagnosed, favorable risk prostate cancer. Post-magnetic resonance imaging biopsy is a stronger driver of decision making than magnetic resonance imaging alone. This was demonstrated by the more than 90% of men with reassuring post-magnetic resonance imaging biopsies who elected active surveillance regardless of magnetic resonance imaging results.
Authors
Ginsburg, KB; Arcot, R; Qi, J; Linsell, SM; Kaye, DR; George, AK; Cher, ML; MUSIC,
MLA Citation
Ginsburg, Kevin B., et al. “Confirmatory Magnetic Resonance Imaging with or without Biopsy Impacts Decision Making in Newly Diagnosed Favorable Risk Prostate Cancer..” J Urol, vol. 201, no. 5, May 2019, pp. 923–28. Pubmed, doi:10.1097/JU.0000000000000059.
URI
https://scholars.duke.edu/individual/pub1426594
PMID
30694939
Source
pubmed
Published In
The Journal of Urology
Volume
201
Published Date
Start Page
923
End Page
928
DOI
10.1097/JU.0000000000000059

Robotic ultrasound and needle guidance for prostate cancer management: review of the contemporary literature.

PURPOSE OF REVIEW: To present the recent advances in needle guidance and robotic ultrasound technology which are used for prostate cancer (PCa) diagnosis and management. RECENT FINDINGS: Prostate biopsy technology has remained relatively unchanged. Improved needle localization and precision would allow for better management of this common disease. Robotic ultrasound and needle guidance is one strategy to improve needle localization and diagnostic accuracy of PCa. This review focuses on the recent advances in robotic ultrasound and needle guidance technologies, and their potential impact on PCa diagnosis and management. SUMMARY: The use of robotic ultrasound and robotic-assisted needle guidance has the potential to improve PCa diagnosis and management.
Authors
Kaye, DR; Stoianovici, D; Han, M
MLA Citation
Kaye, Deborah R., et al. “Robotic ultrasound and needle guidance for prostate cancer management: review of the contemporary literature..” Curr Opin Urol, vol. 24, no. 1, Jan. 2014, pp. 75–80. Pubmed, doi:10.1097/MOU.0000000000000011.
URI
https://scholars.duke.edu/individual/pub1426613
PMID
24257431
Source
pubmed
Published In
Curr Opin Urol
Volume
24
Published Date
Start Page
75
End Page
80
DOI
10.1097/MOU.0000000000000011

Pathological upgrading at radical prostatectomy for patients with Grade Group 1 prostate cancer: implications of confirmatory testing for patients considering active surveillance.

OBJECTIVE: To examine the association between National Comprehensive Cancer Network (NCCN) risk, number of positive biopsy cores, age, and early confirmatory test results on pathological upgrading at radical prostatectomy (RP), in order to better understand whether early confirmatory testing and better risk stratification are necessary for all men with Grade Group (GG) 1 cancers who are considering active surveillance (AS). PATIENTS AND METHODS: We identified men in Michigan initially diagnosed with GG1 prostate cancer, from January 2012 to November 2017, who had a RP within 1 year of diagnosis. Our endpoints were: (i) ≥GG2 cancer at RP and (ii) adverse pathology (≥GG3 and/or ≥pT3a). We compared upgrading according to NCCN risk, number of positive biopsy cores, and age. Last, we examined if confirmatory test results were associated with upgrading or adverse pathology at RP. RESULTS: Amongst 1966 patients with GG1 cancer at diagnosis, the rates of upgrading to ≥GG2 and adverse pathology were 40% and 59% (P < 0.001), and 10% and 17% (P = 0.003) for patients with very-low- and low-risk cancers, respectively. Upgrading by volume ranged from 49% to 67% for ≥GG2, and 16% to 23% for adverse pathology. Generally, more patients aged ≥70 vs <70 years had adverse pathology. Unreassuring confirmatory test results had a higher likelihood of adverse pathology than reassuring tests (35% vs 18%, P = 0.017). CONCLUSIONS: Upgrading and adverse pathology are common amongst patients initially diagnosed with GG1 prostate cancer. Early use of confirmatory testing may facilitate the identification of patients with more aggressive disease ensuring improved risk classification and safer selection of patients for AS.
Authors
Kaye, DR; Qi, J; Morgan, TM; Linsell, S; Ginsburg, KB; Lane, BR; Montie, JE; Cher, ML; Miller, DC; Michigan Urological Surgery Improvement Collaborative,
MLA Citation
URI
https://scholars.duke.edu/individual/pub1426597
PMID
30248225
Source
pubmed
Published In
Bju Int
Volume
123
Published Date
Start Page
846
End Page
853
DOI
10.1111/bju.14554