828 HOSPITAL-LEVEL ADOPTION OF LAPAROSCOPIC RADICAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 2010828 HOSPITAL-LEVEL ADOPTION OF LAPAROSCOPIC RADICAL NEPHRECTOMY Jonathan D. Harper, Michael P. Porter, and John L. Gore Jonathan D. HarperJonathan D. Harper More articles by this author , Michael P. PorterMichael P. Porter More articles by this author , and John L. GoreJohn L. Gore More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1529AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Long-term follow-up confirms equivalent oncologic outcomes for laparoscopic radical nephrectomy (LRN) compared with open radical nephrectomy. For unknown reasons, utilization of laparoscopy for nephrectomy has not increased in the same manner as diffusion of laparoscopy in other fields. The purpose of this study was to examine statewide and individual hospital-level trends in adoption of LRN. METHODS From the Washington State Comprehensive Hospital Abstract Reporting System (CHARS), we identified all patients undergoing radical nephrectomy from 1998-2007 based on International Classification of Diseases, 9th Edition ( ICD-9) procedure codes. According to a published algorithm, we identified those undergoing LRN from indirect ICD-9 procedure codes. Utilization of LRN was examined for each hospital statewide for each study year. RESULTS Use of radical nephrectomy increased by 38% over the 10-year period. The proportion of subjects undergoing LRN increased, although to a lesser degree (0.9% of radical nephrectomies in 1998, 13.6% in 2007, a 12.7% increase). In 59 hospitals at least one nephrectomy was performed, 38 (64%) of which performed a LRN. In 1998, three hospitals performed a LRN (5%), compared with 29 hospitals (49%) in 2007. Stratifying hospitals by nephrectomy volume, those in the lowest volume quartile performed 125 nephrectomies, of which 7 (5.6%) were LRN, compared with the highest volume hospitals, which performed 3451 nephrectomies, of which 347 (10%) were LRN. Only 5 hospitals averaged at least 3 LRNs per year, and accounted for 57% of the increase in LRN over the study period. CONCLUSIONS Uptake of laparoscopic renal surgery in the state of Washington parallels national trends. A handful of hospitals account for the majority of the increase in LRN over the last 10 years. Dissemination of the processes or personnel associated with use of LRN, or regionalization of nephrectomy care may increase the proportion of patients undergoing LRN. Seattle, WA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e323-e324 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan D. Harper More articles by this author Michael P. Porter More articles by this author John L. Gore More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...