John T Leppert1, Harsha R Mittakanti2, I-Chun Thomas2, Remy W Lamberts2, Geoffrey A Sonn3, Benjamin I Chung3, Eila C Skinner3, Todd H Wagner4, Glenn M Chertow5, James D Brooks3. 1. Department of Urology, Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford Kidney Cancer Research Program, Stanford, CA. Electronic address: jleppert@stanford.edu. 2. Department of Urology, Stanford University School of Medicine, Stanford, CA. 3. Department of Urology, Stanford University School of Medicine, Stanford, CA; Stanford Kidney Cancer Research Program, Stanford, CA. 4. Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford Kidney Cancer Research Program, Stanford, CA. 5. Stanford Kidney Cancer Research Program, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA.
Abstract
OBJECTIVE: To assess whether patient factors, such as age and preoperative kidney function, were associated with receipt of partial nephrectomy in a national integrated healthcare system. MATERIALS AND METHODS: We identified patients treated with a radical or partial nephrectomy from 2002 to 2014 in the Veterans Health Administration. We examined associations among patient age, sex, race or ethnicity, multimorbidity, baseline kidney function, tumor characteristics, and receipt of partial nephrectomy. We estimated the odds of receiving a partial nephrectomy and assessed interactions between covariates and the year of surgery to explore whether patient factors associated with partial nephrectomy changed over time. RESULTS: In our cohort of 14,186 patients, 4508 (31.2%) received a partial nephrectomy. Use of partial nephrectomy increased from 17% in 2002 to 32% in 2008 and to 38% in 2014. Patient race or ethnicity, age, tumor stage, and year of surgery were independently associated with receipt of partial nephrectomy. Black veterans had significantly increased odds of receipt of partial nephrectomy, whereas older patients had significantly reduced odds. Partial nephrectomy utilization increased for all groups over time, but older patients and patients with worse baseline kidney function showed the least increase in odds of partial nephrectomy. CONCLUSION: Although the utilization of partial nephrectomy increased for all groups, the greatest increase occurred in the youngest patients and those with the highest baseline kidney function. These trends warrant further investigation to ensure that patients at the highest risk of impaired kidney function are considered for partial nephrectomy whenever possible. Published by Elsevier Inc.
OBJECTIVE: To assess whether patient factors, such as age and preoperative kidney function, were associated with receipt of partial nephrectomy in a national integrated healthcare system. MATERIALS AND METHODS: We identified patients treated with a radical or partial nephrectomy from 2002 to 2014 in the Veterans Health Administration. We examined associations among patient age, sex, race or ethnicity, multimorbidity, baseline kidney function, tumor characteristics, and receipt of partial nephrectomy. We estimated the odds of receiving a partial nephrectomy and assessed interactions between covariates and the year of surgery to explore whether patient factors associated with partial nephrectomy changed over time. RESULTS: In our cohort of 14,186 patients, 4508 (31.2%) received a partial nephrectomy. Use of partial nephrectomy increased from 17% in 2002 to 32% in 2008 and to 38% in 2014. Patient race or ethnicity, age, tumor stage, and year of surgery were independently associated with receipt of partial nephrectomy. Black veterans had significantly increased odds of receipt of partial nephrectomy, whereas older patients had significantly reduced odds. Partial nephrectomy utilization increased for all groups over time, but older patients and patients with worse baseline kidney function showed the least increase in odds of partial nephrectomy. CONCLUSION: Although the utilization of partial nephrectomy increased for all groups, the greatest increase occurred in the youngest patients and those with the highest baseline kidney function. These trends warrant further investigation to ensure that patients at the highest risk of impaired kidney function are considered for partial nephrectomy whenever possible. Published by Elsevier Inc.
Authors: Borje Ljungberg; Karim Bensalah; Steven Canfield; Saeed Dabestani; Fabian Hofmann; Milan Hora; Markus A Kuczyk; Thomas Lam; Lorenzo Marconi; Axel S Merseburger; Peter Mulders; Thomas Powles; Michael Staehler; Alessandro Volpe; Axel Bex Journal: Eur Urol Date: 2015-01-21 Impact factor: 20.096
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: Rodney H Breau; Paul L Crispen; Rafael E Jimenez; Christine M Lohse; Michael L Blute; Bradley C Leibovich Journal: J Urol Date: 2010-01-18 Impact factor: 7.450
Authors: Marc A Bjurlin; Dawn Walter; Glen B Taksler; William C Huang; James S Wysock; Ganesh Sivarajan; Stacy Loeb; Samir S Taneja; Danil V Makarov Journal: Urology Date: 2013-12 Impact factor: 2.649
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: 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: Francine C Gachupin; Benjamin R Lee; Juan Chipollini; Kathryn R Pulling; Alejandro Cruz; Ava C Wong; Celina I Valencia; Chiu-Hsieh Hsu; Ken Batai Journal: Int J Environ Res Public Health Date: 2022-01-21 Impact factor: 3.390