MP16-10 EQUITABLE COMMUNITY UTILIZATION OF PARTIAL NEPHRECTOMY NATIONALLY FOR MANAGEMENT OF T1A RENAL TUMORS

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2015MP16-10 EQUITABLE COMMUNITY UTILIZATION OF PARTIAL NEPHRECTOMY NATIONALLY FOR MANAGEMENT OF T1A RENAL TUMORS Dhruti Patel and Robert Abouassaly Dhruti PatelDhruti Patel More articles by this author and Robert AbouassalyRobert Abouassaly More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.817AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous outcomes research based on the NIS and SEER data has indicated continued underuse of partial nephrectomy as a management strategy for T1a renal masses. Part of this was attributed to the poor diffusion into the community, which we sought to further analyze with the National Cancer Database. METHODS The National Cancer Database captures over seventy percent of newly diagnosed cancer cases in the United States. The national utilization of partial nephrectomy for localized T1a renal masses from 1998 to 2011 was evaluated based on hospital type, either Comprehensive Community Cancer Centers (CCCC) or Academic Cancer Centers (ACC). Only clear cell adenocarcinoma, renal cell carcinoma, papillary adenocarcinoma, chromophobe renal cell carcinoma, sarcomatoid renal cell carcinoma, cystic renal cell carcinoma, and collecting duct renal cell carcinoma were included. Multivariate linear regression and chi-square analyses were performed to evaluate the differences between variables. RESULTS 240,309 cases were identified from 1998 to 2011 with 52% undergoing partial nephrectomy. At both hospital types, utilization of partial nephrectomy annually for T1a renal cancers has statistically significantly (p<0.0001) increased to become the treatment of over half (53%) of all newly diagnosed cases. Based on a multivariate logistic regression, there are a number of factors that affect the utilization of partial nephrectomy. Younger age, white race, private insurance, male gender, hospital type and year all affect the likelihood of partial nephrectomy utilization for T1a tumors. The c statistic for the multivariate linear regression was 0.75. The likelihood of partial nephrectomy is still higher at ACC compared to CCCC (p<0.0001), though a significant number are performed at each hospital type. Both hospital types have similar length of stay, positive surgical margin, 30 day mortality and readmission rates. CONCLUSIONS There has been in a clear shift in the management of T1a renal masses with continued increases in the utilization of partial nephrectomy. This surgical treatment continues to be prevalent in the academic hospital setting and has diffused into the community. This shift may be indicative of the rigorous residency training across the country. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e171 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dhruti Patel More articles by this author Robert Abouassaly More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...