Trends in renal cancer surgery and patient provider characteristics associated with partial nephrectomy in the United States

doi:10.1016/j.urolonc.2006.07.016

Urologic Oncology: Seminars and Original Investigations

Volume 25, Issue 4, July–August 2007, Pages 298-302

https://doi.org/10.1016/j.urolonc.2006.07.016 Get rights and content

Abstract

Objective

Many renal tumors are amenable to either partial or total nephrectomy, but little is known about the relative frequency that these procedures are performed in the United States. We describe recent temporal trends in surgery for renal neoplasm and identified factors associated with partial nephrectomy.

Methods

Data from the 1998 through 2002 National Inpatient Sample was analyzed to identify adult patients discharged after renal cancer surgery. The frequency of partial and total nephrectomy in the United States was estimated, and multivariate regression was used to examine patient and provider factors associated with partial nephrectomy.

Results

The number of nephrectomies performed for tumor in the United States increased yearly, with an estimated 23,375 total nephrectomies and 4272 partial nephrectomies performed in 2002. The ratio of partial nephrectomies to total nephrectomies also increased (P < 0.001), with partial nephrectomy representing 15.5% of all nephrectomies in 2002. In the multivariate analysis, patient and provider factors significantly associated with undergoing partial nephrectomy included female sex (odds ratio [OR] = 0.86, 95% confidence interval [CI] 0.79–0.94), age (OR = 0.38, 95% CI 0.30–0.49 comparing age older than 79 to younger than 40 years), teaching hospital status (OR = 1.54, 95% CI 1.34–1.76), annual hospital nephrectomy volume (OR = 1.96, 95% CI 1.62–2.39 comparing highest to lowest quartiles), annual surgeon nephrectomy volume (OR = 2.60, 95% CI 2.12–3.20 comparing highest to lowest quartiles), and private insurance/health maintenance organization coverage (OR = 1.25, 95% CI 1.11–1.40 compared to Medicare).

Conclusions

The total number of nephrectomies and the proportion of partial nephrectomies performed in the United States increased yearly from 1998 to 2002. Male sex, hospital teaching status, higher hospital and surgeon volume, and insurance status are associated with receiving partial nephrectomy.

Introduction

In 2005, an estimated 36,160 incident cases of kidney cancer occurred in the United States, with an estimated 12,660 deaths [1]. The majority of newly diagnosed tumors will be localized to the kidney, and the incidence of these organ-confined renal cancers is increasing [2]. The current standard of care for clinically organ-confined renal cancer is nephrectomy, with patients having more than 90% 5-year overall survival rates for pathologically organ-confined disease.

Either total or partial nephrectomy is performed to primarily treat organ-confined renal tumors. Although there are specific relative indications for each of these procedures, many patients are candidates for either procedure. Partial nephrectomy offers maximal preservation of normal renal tissue, however, it is more technically demanding and is associated with increased risk of perioperative secondary procedures [3]. Therefore, it is still considered acceptable practice to remove an entire kidney for a renal mass if the contralateral kidney is normal. Despite this, similar cancer control rates [4] and safety profiles [5] have led some urologic surgeons to advocate partial nephrectomy as the “gold standard” for treating small renal tumors [6].

There are limited data on the number of partial and total nephrectomies performed in the United States, and, to our knowledge, no studies have examined if clinical or demographic factors are associated with undergoing either total or partial nephrectomy. The goals of this study were to determine the frequency of total and partial nephrectomy, and examine patient, provider, and demographic characteristics associated with these procedures.

Section snippets

Data source

Discharge data from the National Inpatient Sample for the years 1998–2002 were analyzed. The National Inpatient Sample is a multilevel probability sample of hospital discharges in the United States, and is maintained by the Healthcare Cost and Utilization Project [7]. It contains discharge level administrative data from 995 hospitals, representing approximately 20% of the hospitals in the United States. The sampling design of the National Inpatient Sample allows valid assessments of health care

Results

The selection process resulted in a study population representing 117,078 patient discharges. A total of 103,315 patients underwent total nephrectomy, and 13,763 underwent partial nephrectomy. Demographic characteristics are given in Table 1.

Between 1998 and 2002, the total number of nephrectomies performed in the United States increased yearly (Fig. 1). Over the same period, the ratio of partial to total nephrectomies also increased (trend test P < 0.001; Fig. 2).

Women were less likely to

Discussion

There have been few previous studies examining trends in renal surgery for neoplasm. In 2001, Rosin et al. [9] published a single institution series of 309 patients who underwent nephrectomy between 1970 and 1996. Of 123 patients with neoplasm, they found that the partial nephrectomy rate increased from 24% in the 1970s to 73% between 1986 and 1996. In 1997, Marshall et al. [10] published the results of an analysis using the National Cancer Database. Of all patients treated surgically for renal

Acknowledgments

This article represents research completed in part while Dr. Porter was a Veterans Administration fellow in the Robert Wood Johnson Clinical Scholars Program. The opinions in this article are those of the authors and do not necessarily represent those of the Robert Wood Johnson Foundation or the Veterans Administration.

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Original articleTrends in renal cancer surgery and patient provider characteristics associated with partial nephrectomy in the United States

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Data source

Results

Discussion

Acknowledgments

J Urol

J Urol

J Urol

Urology

J Urol

Cancer facts and figures–2005

Comparison of complications after radical and partial nephrectomy: Results from the National Veterans Administration Surgical Quality Improvement Program

BJU Int

Original article
Trends in renal cancer surgery and patient provider characteristics associated with partial nephrectomy in the United States