Stephen Ali1,2, Thomas Ahn3,4, Nathan Papa5, Marlon Perera3,5, Patrick Teloken3, Geoffrey Coughlin6, Simon T Wood3,7, Matthew J Roberts3,4,8. 1. Department of Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia. 2. Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia. 3. Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 4. Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. 5. Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia. 6. Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. 7. Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Queensland, Australia. 8. Nepean Urology Research Group, Nepean Hospital, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: Guidelines recommend nephron sparing surgery where possible for patients with T1 renal tumours. The trends of nephron sparing surgery outside the USA are limited, particularly since the introduction of robotic-assisted partial nephrectomy (RAPN). The aim of this study was to describe contemporary surgical management patterns of renal tumours in Australia according to Medicare claims data. METHODS: Claims data according to the Medicare Benefits Schedule on surgical management of renal tumours in adult Australians between January 2000 and December 2016 was collated. Analysis of absolute number, population-adjusted rate and renal cancer-adjusted rate of interventions according to age and gender were performed, as well as proportion of RAPN. RESULTS: Between 2000 and 2016, the rate of partial nephrectomy (PN) increased while radical nephrectomy (RN) remained stable (PN: 0.87-4.16, RN: 6.52-6.70 per 100 000 population). Since 2015, PN has become more common than RN in patients aged 25 to 44 years (0.98 versus 0.95 procedures per 100 000 population). Renal cancer-adjusted rate exhibited a trend towards increasing utilization of PN and reduced RN across all age groups. An increase in overall surgical treatment was observed (25%-41%), mainly due to increased treatment of patients older than 75 years. The proportion of RAPN was seen to rapidly increase (4.7% in 2010 to 58% in 2016). CONCLUSIONS: Treatment utilization for renal masses has markedly changed in Australia according to Medicare claims. PN is increasingly replacing RN in younger patients, and older patients are receiving more surgical treatment. The impact of increased RAPN utilization is yet to be determined.
BACKGROUND: Guidelines recommend nephron sparing surgery where possible for patients with T1 renal tumours. The trends of nephron sparing surgery outside the USA are limited, particularly since the introduction of robotic-assisted partial nephrectomy (RAPN). The aim of this study was to describe contemporary surgical management patterns of renal tumours in Australia according to Medicare claims data. METHODS: Claims data according to the Medicare Benefits Schedule on surgical management of renal tumours in adult Australians between January 2000 and December 2016 was collated. Analysis of absolute number, population-adjusted rate and renal cancer-adjusted rate of interventions according to age and gender were performed, as well as proportion of RAPN. RESULTS: Between 2000 and 2016, the rate of partial nephrectomy (PN) increased while radical nephrectomy (RN) remained stable (PN: 0.87-4.16, RN: 6.52-6.70 per 100 000 population). Since 2015, PN has become more common than RN in patients aged 25 to 44 years (0.98 versus 0.95 procedures per 100 000 population). Renal cancer-adjusted rate exhibited a trend towards increasing utilization of PN and reduced RN across all age groups. An increase in overall surgical treatment was observed (25%-41%), mainly due to increased treatment of patients older than 75 years. The proportion of RAPN was seen to rapidly increase (4.7% in 2010 to 58% in 2016). CONCLUSIONS: Treatment utilization for renal masses has markedly changed in Australia according to Medicare claims. PN is increasingly replacing RN in younger patients, and older patients are receiving more surgical treatment. The impact of increased RAPN utilization is yet to be determined.
Authors: Nassib Abou Heidar; Nizar Hakam; Jose M El-Asmar; Jad Najdi; Mark A Khauli; Jad Degheili; Albert El-Hajj; Rami Nasr; Wassim Wazzan; Muhammad Bulbul; Deborah Mukherji; Raja Khauli Journal: Arab J Urol Date: 2022-04-17