PD40-03 PRACTICE AND SURGEON-LEVEL VARIATION IN THE SURGICAL MANAGEMENT OF T1A RENAL MASSES: RESULTS FROM A STATEWIDE COLLABORATIVE

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD40-03 PRACTICE AND SURGEON-LEVEL VARIATION IN THE SURGICAL MANAGEMENT OF T1A RENAL MASSES: RESULTS FROM A STATEWIDE COLLABORATIVE Samantha Wilder, Mahmoud Hijazi, Ananya Vittal, Ji Qi, Mahin Mirza, Mohammad Jafri, Brian Lane, Craig Rogers, and for the Michigan Urological Surgery Improvement Collaborative Samantha WilderSamantha Wilder More articles by this author , Mahmoud HijaziMahmoud Hijazi More articles by this author , Ananya VittalAnanya Vittal More articles by this author , Ji QiJi Qi More articles by this author , Mahin MirzaMahin Mirza More articles by this author , Mohammad JafriMohammad Jafri More articles by this author , Brian LaneBrian Lane More articles by this author , Craig RogersCraig Rogers More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003345.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current guidelines recommend prioritizing partial nephrectomy (PN) over radical nephrectomy (RN) in the management of cT1a renal masses (T1aRM). We examined variation in PN use for surgically treated T1aRM and identified factors associated with PN use in the MUSIC-KIDNEY collaborative. METHODS: All patients in the MUSIC-KIDNEY registry undergoing surgery for T1aRM between 5/2017 and 5/2022 were included. Practice- and surgeon-level variation in use of PN (vs RN) were evaluated among those who treated at least 5 patients surgically. Multivariable mixed-effects logistic regression model was performed to identify factors associated with PN use. Rates of prolonged hospitalization (>3 days for minimally invasive, >5 days for open), 30-day emergency department (ED) visits, and 30-day readmissions were compared between patients undergoing PN and RN, using Chi-squared test or Fisher’s exact test. RESULTS: 1014 surgically treated T1aRM patients from 14 practices and 68 surgeons were included. Among these, 843 (83%) underwent PN and 171 (17%) underwent RN. Rates of utilization of PN ranged from 50-93% across practices and 38-100% across surgeons (Figure 1). Low patient comorbidity, preoperative GFR>60, and low nephrometry score (RENL 4-6) were associated with increased use of PN (p<0.05). Postoperative ED visit rates were low for both RN and PN (3.5% vs 2.6%) and did not differ significantly (p>0.05). RN was associated with higher rates of prolonged hospitalization (19% vs 7.7%, p<0.05) and readmission (5.9% vs 2.9%, p<0.05). CONCLUSIONS: Over 80% of surgically treated T1aRM underwent PN in MUSIC-KIDNEY with variation across practices and surgeons. Association of high preoperative GFR with PN may be related to the high rates of surveillance (>50%) for T1aRM in MUSIC-KIDNEY for masses that may have otherwise undergone PN. Higher rates of prolonged hospitalization and readmission for RN may be related to higher baseline comorbidity. Quality improvement initiatives within MUSIC-KIDNEY include a PN video library and live peer-to-peer review sessions with the goal of increasing surgeon comfort and skill in PN. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1052 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samantha Wilder More articles by this author Mahmoud Hijazi More articles by this author Ananya Vittal More articles by this author Ji Qi More articles by this author Mahin Mirza More articles by this author Mohammad Jafri More articles by this author Brian Lane More articles by this author Craig Rogers More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...