You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making III1 Apr 2017MP69-15 RECEIPT OF MANNITOL USE IN PARTIAL NEPHRECTOMY AND RATES OF CONVERSION TO RADICAL NEPHRECTOMY AFTER MANNITOL ADMINISTRATION Yash Khandwala, In Gab Jeong, Ye Wang, Deok Hyun Han, Jae Heon Kim, Shufeng Li, Steven L Chang, and Benjamin Chung Yash KhandwalaYash Khandwala More articles by this author , In Gab JeongIn Gab Jeong More articles by this author , Ye WangYe Wang More articles by this author , Deok Hyun HanDeok Hyun Han More articles by this author , Jae Heon KimJae Heon Kim More articles by this author , Shufeng LiShufeng Li More articles by this author , Steven L ChangSteven L Chang More articles by this author , and Benjamin ChungBenjamin Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2311AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Accurate rates of mannitol use for partial nephrectomy (PN) and subsequent intra-operative conversion from PN to radical nephrectomy (RN) are unknown. Understanding factors predictive for conversion and ascertaining surgical outcomes of these converted nephrectomies would contribute greatly to the literature and also allow clinicians to better counsel prospective patients. Thus, we sought to calculate conversion rates of both open and minimally invasive PN using mannitol usage as an indicator for PN intent and to identify factors associated with the conversion from PN to RN. METHODS A total of 136,298 patients undergoing PN (open: n=68,580, laparoscopic: n=17,549, robotic: n=50,169) and 423,759 undergoing RN (open: n=237,411, laparoscopic: n=143,179, robotic: n=43,169) were identified from the Premier Perspective Database, an all-payer hospital clinical and economic database in the U.S. capturing patients from 2003 to 2015. An algorithm utilizing a variety of charge and billing codes based on the use of mannitol osmotic diuretic in RN was used to calculate rates of conversion. RESULTS Overall, mannitol was used in 41.7% of the total PN cohort (open: 32.4%, laparoscopic: 21.7%, robotic: 59.9%, p <0.001). After adjusting for the use of mannitol, the conversion rate of PN to RN was 27.9% for open, 42.6% for laparoscopic, and 14.2% for the robotic approach (p <0.001). Multivariate analysis found that age, gender, charlson comorbidity index, surgical approach, surgery year, and annual surgeon and hospital volume were independent factors associated with conversion from PN to RN (all p<0.001). After adjusting for patient, surgeon and hospital demographics, laparoscopic approach had higher odds (OR=1.77, 95% CI 1.5 to 2.2, p=<0.001) and the robotic-approach had lower odds (OR=0.62, 95% CI 0.54-0.71, p<0.001) of conversion compared to open surgery. CONCLUSIONS Robot-assisted PN had higher usage rates of mannitol compared to laparoscopic and open approaches. Also, robotic PN had the lowest odds of PN to RN conversion while the laparoscopic approach had the highest odds of conversion. Clinicians should be aware of these conversion rates especially prior to undertaking technically difficult nephron sparing procedures irrespective of approach. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e932 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yash Khandwala More articles by this author In Gab Jeong More articles by this author Ye Wang More articles by this author Deok Hyun Han More articles by this author Jae Heon Kim More articles by this author Shufeng Li More articles by this author Steven L Chang More articles by this author Benjamin Chung More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...