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National Trends in the Use of Partial Nephrectomy: A Rising Tide That Has Not Lifted All Boats

2012; Lippincott Williams & Wilkins; Volume: 187; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2011.10.173

1527-3792

Sanjay G. Patel, David F. Penson, Pabla Baldeep, Peter E. Clark, Michael S. Cookson, Sam S. Chang, S. Duke Herrell, Joseph A. Smith, Daniel A. Barocas,

Organ Donation and Transplantation

No AccessJournal of UrologyAdult Urology1 Mar 2012National Trends in the Use of Partial Nephrectomy: A Rising Tide That Has Not Lifted All Boats Sanjay G. Patel, David F. Penson, Baldeep Pabla, Peter E. Clark, Michael S. Cookson, Sam S. Chang, S. Duke Herrell, Joseph A. Smith, and Daniel A. Barocas Sanjay G. PatelSanjay G. Patel Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , David F. PensonDavid F. Penson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee Vanderbilt University Medical Center, Tennessee Valley Veterans Administration Health System, Nashville, Tennessee , Baldeep PablaBaldeep Pabla Vanderbilt University School of Medicine, Nashville, Tennessee , Peter E. ClarkPeter E. Clark Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , Michael S. CooksonMichael S. Cookson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , Sam S. ChangSam S. Chang Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , S. Duke HerrellS. Duke Herrell Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , Joseph A. SmithJoseph A. Smith Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , and Daniel A. BarocasDaniel A. Barocas Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee View All Author Informationhttps://doi.org/10.1016/j.juro.2011.10.173AboutFull TextPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Treatment of organ confined renal masses with partial nephrectomy has durable oncologic outcomes comparable to radical nephrectomy. Partial nephrectomy is associated with lower risk of chronic kidney disease and in some series with better overall survival. We report a contemporary analysis on national trends of partial nephrectomy use to determine partial nephrectomy use over time, and whether nontumor related factors such as structural attributes of the treating institution or patient characteristics are associated with the underuse of partial nephrectomy. Materials and Methods: We performed an analysis of the NIS (National Inpatient Sample), which contains 20% of all United States inpatient hospitalizations. We included patients who underwent radical or partial nephrectomy for a renal mass between 2002 and 2008. Survey weights were applied to obtain national estimates of nephrectomy use and to evaluate nonclinical predictors of partial nephrectomy. Results: A total of 46,396 patients were included in the study for a weighted sample of 226,493. There was an increase in partial nephrectomy use from 15.3% in 2002 to 24.7% in 2008 (p <0.001). On multivariate analysis hospital attributes (urban teaching status, nephrectomy volume, geographic region) and patient socioeconomic status (higher income ZIP code and private/HMO payer) were independent predictors of partial nephrectomy use. Conclusions: Since 2002 the national use of partial nephrectomy for the management of renal masses has increased. However, the adoption of partial nephrectomy at smaller, rural and nonacademic hospitals lags behind that of larger hospitals, urban/teaching hospitals and higher volume centers. A lower rate of partial nephrectomy use among patients without private insurance and those living in lower income ZIP code areas highlights the underuse of partial nephrectomy as a quality of care concern. References 1 : Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of Surveillance, Epidemiology and End Results program data. J Urol2002; 167: 57. 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Smaldone M and Kutikov A (2012) Assessing the management of localized kidney cancerNature Reviews Urology, 10.1038/nrurol.2012.45, VOL. 9, NO. 4, (186-188), Online publication date: 1-Apr-2012. Volume 187Issue 3March 2012Page: 816-821 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordskidney neoplasmsphysician's practice patternsnephrectomyMetrics Author Information Sanjay G. Patel Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author David F. Penson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee Vanderbilt University Medical Center, Tennessee Valley Veterans Administration Health System, Nashville, Tennessee More articles by this author Baldeep Pabla Vanderbilt University School of Medicine, Nashville, Tennessee More articles by this author Peter E. Clark Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Galil Medical. More articles by this author Michael S. Cookson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Endo. More articles by this author Sam S. Chang Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Sanofi-Aventis, Endo, Allergan and Centocor Ortho Biotech. More articles by this author S. Duke Herrell Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Aesculap Inc., Covidien Surgical Devices, Veran Medical Tech, Wilex and Galil Medical. More articles by this author Joseph A. Smith Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Steba Pharmaceuticals. More articles by this author Daniel A. Barocas Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Ferring, Dendreon and Allergan. More articles by this author Expand All Advertisement PDF downloadLoading ...