INTRODUCTION: While high volume and academic hospitals have been associated with greater use of partial nephrectomy (PN) performed for renal cell carcinoma (RCC), the effect of robotic technology on PN use remains unknown.
Therefore, we sought to evaluate the relationship of PN and hospital availability of robotic surgery from a population-based cohort in the U.S.
METHODS: After merging the Nationwide Inpatient Sample (NIS) and the American Hospital Association (AHA) survey from 2006 to 2008, we identified 21,179 patients who underwent either PN or radical nephrectomy (RN) for RCC. The primary outcome was the type of nephrectomy performed. Multivariable logistic regression identified patient and hospital characteristics associated with receipt of PN.
RESULTS: We identified 4,832 (22.8%) and 16,347 (77.2%) patients who were treated for RCC with PN and RN, respectively. On multivariable analysis, patients were more likely to receive PN at academic (OR: 2.77; p< 0.001), urban (OR: 3.66; p< 0.001), and American College of Surgeon (ACOS) designated cancer centers (OR: 1.10; p< 0.05) compared to non-academic, rural, and non-designated cancer center hospitals, respectively. Robotic availability at a hospital was associated with higher adjusted odds of PN compared centers without robotic surgery (OR: 1.28; p< 0.001).
CONCLUSIONS: While academic and urban locations are established characteristics influencing receipt of PN for RCC, the presence of robotic surgery at a hospital was also independently associated with higher use of PN. Our results are informative in identifying other key hospital characteristics which may facilitate greater adoption of PN.
Written by:
Kardos SV, Gross CP, Shah ND, Schulam PG, Trinh QD, Smaldone MC, Sun M, Weight CJ, Sammon J, Han LC, Kim SP. Are you the author?
Yale University, Department of Urology, New Haven, Connecticut.
Reference: BJU Int. 2014 Feb 27. Epub ahead of print.
doi: 10.1111/bju.12711
PubMed Abstract
PMID: 24571281
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