MP47-06 CONTEMPORARY NATIONAL TRENDS IN PARTIAL NEPHRECTOMY UTILIZATION FOR RENAL CANCER: A REAL-WORLD STUDY USING THE NATIONAL INPATIENT SAMPLE DATABASE

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP47-06 CONTEMPORARY NATIONAL TRENDS IN PARTIAL NEPHRECTOMY UTILIZATION FOR RENAL CANCER: A REAL-WORLD STUDY USING THE NATIONAL INPATIENT SAMPLE DATABASE Sanjana Ranganathan, Carlos Riveros, Jiaqiong Xu, Courtney Chang, Michael Geng, Zachary Klaassen, Christopher J. D. Wallis, and Raj Satkunasivam Sanjana RanganathanSanjana Ranganathan More articles by this author , Carlos RiverosCarlos Riveros More articles by this author , Jiaqiong XuJiaqiong Xu More articles by this author , Courtney ChangCourtney Chang More articles by this author , Michael GengMichael Geng More articles by this author , Zachary KlaassenZachary Klaassen More articles by this author , Christopher J. D. WallisChristopher J. D. Wallis More articles by this author , and Raj SatkunasivamRaj Satkunasivam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) has become a preferred approach for small renal masses (SRMs) (<T1a) and similarly amenable tumors in recent years. Compared to radical nephrectomy (RN), PN can mitigate the risk of progression to chronic kidney disease (CKD) while yielding equivalent oncologic outcomes in select patients. Though the benefits of PN are known, the extent of diffusion of the technique and real-world factors influencing patient selection remain unclear. We aim to better understand temporal trends in PN utilization and elucidate patient and facility characteristics associated with PN. METHODS: We identified patients in the National Inpatient Sample (NIS) diagnosed with renal cancer and treated with PN or RN from 2014 to 2019. We accounted for a lack of pathologic and staging data in the NIS by excluding patients with concomitant diagnoses and procedures indicative of increased case complexity. We performed multivariable logistic regression modeling to identify factors associated with nephrectomy type and examined trends in proportion of PN use using a Wilcoxon-type test for trend. RESULTS: A total of 39,983 patients were identified; 15,915 (39.8%) treated with PN and 24,068 (60.2%) with RN. Multivariable analysis (Table 1) identified increased age, comorbid CKD, and self-pay status to be associated with increased likelihood of receiving RN. Higher income quartile, private insurance status, treatment at an urban teaching facility, and treatment at a high nephrectomy volume facility were associated with increased likelihood of receiving PN. We found no trend in PN use over the study period (p=0.08). Limitations include lack of granular data on tumor staging and differences in case complexity influencing treatment decisions. CONCLUSIONS: Contemporary adoption of PN has been slow and requires further study, particularly in the context of increasing use of ablative therapy and active surveillance for SRMs. These data suggest that some patients, particularly those not treated at teaching or high nephrectomy volume facilities as well as those without financial means or insurance coverage, may not have the option of receiving PN despite having potentially amenable tumors. Source of Funding: Sanjana Ranganathan is a Burroughs Wellcome Fund Scholar supported by a Burroughs Wellcome Fund Physician Scientist Institutional Award to the Texas A&M University Academy of Physician Scientists © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e645 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sanjana Ranganathan More articles by this author Carlos Riveros More articles by this author Jiaqiong Xu More articles by this author Courtney Chang More articles by this author Michael Geng More articles by this author Zachary Klaassen More articles by this author Christopher J. D. Wallis More articles by this author Raj Satkunasivam More articles by this author Expand All Advertisement PDF downloadLoading ...