OBJECTIVE: To assess the impact of the American Urological Association (AUA) guidelines advocating partial nephrectomy for T1 tumors guidelines on the likelihood of undergoing partial nephrectomy. MATERIALS AND METHODS: We analyzed the Nationwide Inpatient Sample (NIS), a dataset encompassing 20% of all United States inpatient hospitalizations, from 2007 through 2010. Our dependent variable was receipt of radical vs partial nephrectomy (55.50, 55.51, 55.52, and 55.54 vs 55.4) for a renal mass (International Classification of Disease, 9th Revision [ICD-9] code 189.0). The independent variable of interest was time of surgery (before or after the establishment of AUA guidelines); covariates included a diagnosis of chronic kidney disease (CKD), overall comorbidity, age, race, gender, geographic region, income, and hospital characteristics. Bivariate and multivariable adjusted logistic regression was used to determine the association between receipt of partial nephrectomy and time of guideline establishment. RESULTS: We identified 26,165 patients with renal tumors who underwent surgery. Before the guidelines, 4031 patients (27%) underwent partial nephrectomy compared to 3559 (32%) after. On multivariable analysis, undergoing surgery after the establishment of guidelines (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.08-1.32, P <.01) was an independent predictor of partial nephrectomy. Other factors associated with partial nephrectomy were urban location, surgery at a teaching hospital, large hospital bed size, Northeast location, and Black race. Female gender and CKD were not associated with partial nephrectomy. CONCLUSION: Although adoption of partial nephrectomy increased after establishment of new guidelines on renal masses, partial nephrectomy remains an underutilized procedure. Future research must focus on barriers to adoption of partial nephrectomy and how to overcome them.
OBJECTIVE: To assess the impact of the American Urological Association (AUA) guidelines advocating partial nephrectomy for T1 tumors guidelines on the likelihood of undergoing partial nephrectomy. MATERIALS AND METHODS: We analyzed the Nationwide Inpatient Sample (NIS), a dataset encompassing 20% of all United States inpatient hospitalizations, from 2007 through 2010. Our dependent variable was receipt of radical vs partial nephrectomy (55.50, 55.51, 55.52, and 55.54 vs 55.4) for a renal mass (International Classification of Disease, 9th Revision [ICD-9] code 189.0). The independent variable of interest was time of surgery (before or after the establishment of AUA guidelines); covariates included a diagnosis of chronic kidney disease (CKD), overall comorbidity, age, race, gender, geographic region, income, and hospital characteristics. Bivariate and multivariable adjusted logistic regression was used to determine the association between receipt of partial nephrectomy and time of guideline establishment. RESULTS: We identified 26,165 patients with renal tumors who underwent surgery. Before the guidelines, 4031 patients (27%) underwent partial nephrectomy compared to 3559 (32%) after. On multivariable analysis, undergoing surgery after the establishment of guidelines (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.08-1.32, P <.01) was an independent predictor of partial nephrectomy. Other factors associated with partial nephrectomy were urban location, surgery at a teaching hospital, large hospital bed size, Northeast location, and Black race. Female gender and CKD were not associated with partial nephrectomy. CONCLUSION: Although adoption of partial nephrectomy increased after establishment of new guidelines on renal masses, partial nephrectomy remains an underutilized procedure. Future research must focus on barriers to adoption of partial nephrectomy and how to overcome them.
Authors: Simon P Kim; Nilay D Shah; Christopher J Weight; R Houston Thompson; James P Moriarty; Nathan D Shippee; Brian A Costello; Stephen A Boorjian; Bradley C Leibovich Journal: J Urol Date: 2011-09-25 Impact factor: 7.450
Authors: Sanjay G Patel; David F Penson; Baldeep Pabla; Peter E Clark; Michael S Cookson; Sam S Chang; S Duke Herrell; Joseph A Smith; Daniel A Barocas Journal: J Urol Date: 2012-01-15 Impact factor: 7.450
Authors: Christopher J Weight; Paul L Crispen; Rodney H Breau; Simon P Kim; Christine M Lohse; Stephen A Boorjian; R Houston Thompson; Bradley C Leibovich Journal: BJU Int Date: 2012-04-13 Impact factor: 5.588
Authors: David C Miller; John M Hollingsworth; Khaled S Hafez; Stephanie Daignault; Brent K Hollenbeck Journal: J Urol Date: 2006-03 Impact factor: 7.450
Authors: John T Leppert; Harsha R Mittakanti; I-Chun Thomas; Remy W Lamberts; Geoffrey A Sonn; Benjamin I Chung; Eila C Skinner; Todd H Wagner; Glenn M Chertow; James D Brooks Journal: Urology Date: 2016-09-12 Impact factor: 2.649
Authors: Abimbola Ayangbesan; David M Golombos; Ron Golan; Padraic O'Malley; Patrick Lewicki; Xian Wu; Douglas S Scherr Journal: J Endourol Date: 2019-01 Impact factor: 2.942
Authors: Jae Heon Kim; Shufeng Li; Yash Khandwala; Francesco Del Giudice; Kyung Jin Chung; Hyung Keun Park; Benjamin I Chung Journal: Can Urol Assoc J Date: 2018-08-30 Impact factor: 1.862
Authors: Robert J Ellis; Daniel P Edey; Sharon J Del Vecchio; Megan McStea; Scott B Campbell; Carmel M Hawley; David W Johnson; Christudas Morais; Susan J Jordan; Ross S Francis; Simon T Wood; Glenda C Gobe Journal: Clin J Am Soc Nephrol Date: 2018-09-28 Impact factor: 8.237
Authors: Aaron M Potretzke; Brent A Knight; John A Brockman; Joel Vetter; Robert S Figenshau; Sam B Bhayani; Brian M Benway Journal: J Robot Surg Date: 2016-04-02
Authors: John T Leppert; Remy W Lamberts; I-Chun Thomas; Benjamin I Chung; Geoffrey A Sonn; Eila C Skinner; Todd H Wagner; Glenn M Chertow; James D Brooks Journal: J Am Soc Nephrol Date: 2017-10-10 Impact factor: 10.121
Authors: Ganesh Sivarajan; Glen B Taksler; Dawn Walter; Cary P Gross; Raul E Sosa; Danil V Makarov Journal: Med Care Date: 2015-01 Impact factor: 2.983
Authors: Steffen Lebentrau; Sven Rauter; Daniel Baumunk; Frank Christoph; Frank König; Matthias May; Martin Schostak Journal: World J Urol Date: 2016-08-12 Impact factor: 4.226