PD16-04 ANALYZING NATIONAL INCIDENCES AND PREDICTORS FOR OPEN CONVERSION DURING MINIMALLY INVASIVE PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III1 Apr 2018PD16-04 ANALYZING NATIONAL INCIDENCES AND PREDICTORS FOR OPEN CONVERSION DURING MINIMALLY INVASIVE PARTIAL NEPHRECTOMY Geraldine Theresa Klein, Eric S Gourley, Hanzang Wang, Elizabeth A Rourke, Michael A Liss, Darham Kaushik, and Ahmed M Mansour Geraldine Theresa KleinGeraldine Theresa Klein More articles by this author , Eric S GourleyEric S Gourley More articles by this author , Hanzang WangHanzang Wang More articles by this author , Elizabeth A RourkeElizabeth A Rourke More articles by this author , Michael A LissMichael A Liss More articles by this author , Darham KaushikDarham Kaushik More articles by this author , and Ahmed M MansourAhmed M Mansour More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.816AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Minimally invasive partial nephrectomy (MIPN) has shown to be a safe and effective alternative approach to open partial nephrectomy (OPN). Increased adoption of MIPN was noted over the past decades. We aimed to analyze predictors for open conversion during MIPN in a contemporary cohort. METHODS Retrospective review of the National Cancer Database (NCDB) for patients diagnosed with renal cell carcinoma who subsequently underwent partial nephrectomy (PN) between 2010 to 2015. Patients who underwent MIPN were identified. We analyzed surgical outcomes and facility characteristics between converted and non-converted cases. A multivariate logistic regression model was fitted to identify independent predictors of open conversion. RESULTS We identified 54,246 patents that underwent PN during the 6-year period. Of these, 18,994 (35%) were OPN and 35,252 (64%) were MIPN, 1,010 (1.86%) of MIPNs were converted to OPN. There was an observed increasing trend in utilization of MIPN from 50.35% in 2010 to 74.73% in 2015. Patients who had open conversion were more likely to have readmission within 30 days (5.95% vs. 3.31%, p<0.01). On multivariate analysis surgery performed at high volume hospitals (>30 MIPNs per year) and year of surgery (2015 vs. 2010) predicted a lower likelihood of conversion (OR 0.50; CI 0.43-0.59, p <0.01 and OR 0.47; CI 0.38-0.58, p<0.01, respectively). Conversely, Medicaid compared to private insurance (OR 1.78; CI 1.42-2.23, p <0.01) and male sex (OR; 1.27 CI 1.11-1.45 p<0.01), were independent predictors of conversion. CONCLUSIONS Over the data period an increase in MIPN is correlated with a 23% decrease in the rate of conversion. Advancing year of surgery also correlates with a decrease in conversion as does surgery at a large volume hospital. Medicaid and male sex correlate with higher rates of conversion. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e317 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Geraldine Theresa Klein More articles by this author Eric S Gourley More articles by this author Hanzang Wang More articles by this author Elizabeth A Rourke More articles by this author Michael A Liss More articles by this author Darham Kaushik More articles by this author Ahmed M Mansour More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...