Abstract
ObjectiveTo find a cutoff of hospital volume for elective partial nephrectomy (PN) for kidney cancer that can minimize the inpatient morbidity of this procedure. Material and methodsAnalyzing the National Inpatient sample, from 2008 to 2011, we selected 8,753 records of adult patients undergoing elective PN for nonmetastatic kidney cancer, representing an estimated 43,178 partial nephrectomies performed in the United States during this period. Of these, 2,187 (estimated 10,848) PNs were performed via the robotic approach. International Classification of Diseases, Ninth Revision, diagnosis and procedure codes were used to define complications. Logistic regression within generalized estimating equation framework, with restricted cubic splines was used to identify the relationship of any inpatient complications and major inpatient complications with annual hospital PN volume, after adjusting for demographic characteristics, insurance status, location, and comorbidities. A similar analysis was done for a subset of patients undergoing robot-assisted PN. ResultsOverall, rate of any inpatient complication and major inpatient complications was 1,801/8,753 (20.6%) and 839/8,753 (9.6%), respectively. Median annual hospital volume was 27 cases (interquartile range: 11–64). Restricted cubic spline analysis revealed a significant inverse nonlinear association between annual hospital volume and any inpatient complications (P<0.001). The odds of complications decreased with increasing annual hospital volume, with plateauing seen at 35 to 40 cases for both any inpatient complications and major inpatient complications. Analysis on a subset of robot-assisted PN revealed a similar inverse nonlinear relationship, with plateauing at 18 to 20 cases annually. ConclusionThere is an inverse nonlinear relationship of hospital volume with morbidity of PN, with a plateauing seen at 35 to 40 cases annually overall, and at 18 to 20 cases for robot-assisted PN.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Urologic Oncology: Seminars and Original Investigations
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
