PD41-06 HOSPITAL AND PATIENT RELATED FACTORS INFLUENCING THE UTILIZATION OF PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2016PD41-06 HOSPITAL AND PATIENT RELATED FACTORS INFLUENCING THE UTILIZATION OF PARTIAL NEPHRECTOMY Arpeet Shah, Robert Blackwell, Anai Kothari, Matthew Zapf, Paul Kuo, and Gopal Gupta Arpeet ShahArpeet Shah More articles by this author , Robert BlackwellRobert Blackwell More articles by this author , Anai KothariAnai Kothari More articles by this author , Matthew ZapfMatthew Zapf More articles by this author , Paul KuoPaul Kuo More articles by this author , and Gopal GuptaGopal Gupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1552AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With the adoption of partial nephrectomy as the standard of care for T1 renal masses, factors regarding barriers to adoption are unclear. The aim of this study was to evaluate hospital and patient related factors influencing the utilization of partial nephrectomy (PN) versus radical nephrectomy (RN) using a large administrative dataset. METHODS A direct database linkage methodology was used to connect the Florida Healthcare Cost and Utilization Project State Inpatient Database, American Hospital Association Annual Survey database, and the Commission on Cancer (CoC) Hospital Locator. From this dataset of 6,412,308 unique inpatient encounters, a study population was generated using ICD-9 and CPT codes to identify all patients with renal malignancy who underwent radical or partial nephrectomy. RESULTS A total of 5,762 patients met our inclusion criteria (1,745 PN and 4,017 RN). Median age of the study population was 64 years. Patients who underwent PN were younger (60 vs 64, p<0.0001) and had lower Charlson co-morbidity indexes (2.79 vs 3.34, p<0.0001). Multivariate analyses demonstrated the odds of undergoing PN increased at teaching hospitals, CoC-accredited cancer centers, and at hospitals performing a high volume of nephrectomies. Of these, high nephrectomy volume centers (>58 per year) was the most significant predictor (see table 1). After controlling for patient factors, full implementation of electronic medical records (EMR) and increasing nurse-to-bed ratio were independent predictors of the likelihood of undergoing PN at both high and low volume centers (see table 2). CONCLUSIONS Hospitals performing high volumes of nephrectomies were a significant determinant for the utilization of PN for the treatment of renal malignancy. Importantly, specific hospital characteristics such as having an implemented EMR and high nurse-to-bed ratio can overcome the limitations of hospital type. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e942 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Arpeet Shah More articles by this author Robert Blackwell More articles by this author Anai Kothari More articles by this author Matthew Zapf More articles by this author Paul Kuo More articles by this author Gopal Gupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...