1185 NATIONAL UTILIZATION OF PARTIAL NEPHRECTOMY BEFORE AND AFTER THE ESTABLISHMENT OF AUA GUIDELINES FOR THE TREATMENT OF SMALL RENAL MASSES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20131185 NATIONAL UTILIZATION OF PARTIAL NEPHRECTOMY BEFORE AND AFTER THE ESTABLISHMENT OF AUA GUIDELINES FOR THE TREATMENT OF SMALL RENAL MASSES Marc A. Bjurlin, Dawn Walter, William C. Huang, James S. Wysock, Ganesh Sivarajan, Stacy Loeb, Samir S. Taneja, and Danil V. Makarov Marc A. BjurlinMarc A. Bjurlin New York, NY More articles by this author , Dawn WalterDawn Walter New York, NY More articles by this author , William C. HuangWilliam C. Huang New York, NY More articles by this author , James S. WysockJames S. Wysock New York, NY More articles by this author , Ganesh SivarajanGanesh Sivarajan New York, NY More articles by this author , Stacy LoebStacy Loeb New York, NY More articles by this author , Samir S. TanejaSamir S. Taneja New York, NY More articles by this author , and Danil V. MakarovDanil V. Makarov New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2539AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Compared to radical nephrectomy for small renal masses, partial nephrectomy (PN) has been shown to provide equivalent oncologic outcomes while minimizing the risk for subsequent renal impairment. To address the recognized underutilization of PN, in April 2009 the American Urological Association presented guidelines advocating PN for T1 tumors. We assessed the impact of these guidelines on the likelihood of a patient admitted with kidney cancer undergoing PN. METHODS We analyzed the Nationwide Inpatient Sample, a dataset containing a 20% sample of all United States inpatient hospitalizations, from 2007 through 2010. Our dependent variable was receipt of radical vs. PN (ICD-9 codes 55.5x vs. 55.4) for a renal mass (ICD-9 code 189.0). Our independent variable of interest was time of surgery (before or after the announcement of AUA guidelines); covariates included diagnosis of CKD, overall comorbidity, age, race, gender, geographic region, income, and hospital characteristics. Bivariate and multivariable adjusted logistic regression was used to determine the association between receipt of partial nephrectomy and time of guideline establishment. RESULTS We identified 26,165 patients with renal tumors who underwent surgery. Prior to the guidelines, 4031 (27%) patients underwent PN compared to 3559 (32%) after. On multivariable analysis, undergoing surgery after the establishment of guidelines [OR 1.28 (95% Cl 1.22-1.36), p<0.01] was an independent predictor of PN. Other factors associated with PN were urban location, surgery at a teaching hospital, large hospital bed-size, Northeast location, and Black race. CONCLUSIONS Utilization of partial nephrectomy was significantly more likely after establishment of AUA guidelines for the management of renal masses; however, partial nephrectomy remains an underutilized procedure. Future research must focus on barriers to adoption of partial nephrectomy and how to overcome them. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e484 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marc A. Bjurlin New York, NY More articles by this author Dawn Walter New York, NY More articles by this author William C. Huang New York, NY More articles by this author James S. Wysock New York, NY More articles by this author Ganesh Sivarajan New York, NY More articles by this author Stacy Loeb New York, NY More articles by this author Samir S. Taneja New York, NY More articles by this author Danil V. Makarov New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...