1650 TRENDS IN RENAL SURGERY: ROBOTIC TECHNOLOGY IS ASSOCIATED WITH INCREASED UTILIZATION OF PARTIAL NEPHRECTOMY

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You have accessJournal of UrologyKidney Cancer: Localized (IV)1 Apr 20131650 TRENDS IN RENAL SURGERY: ROBOTIC TECHNOLOGY IS ASSOCIATED WITH INCREASED UTILIZATION OF PARTIAL NEPHRECTOMY Hiten Patel, Jeffrey Mullins, Phillip Pierorazio, Gautam Jayram, Jason Cohen, Brian Matlaga, and Mohamad Allaf Hiten PatelHiten Patel Baltimore, MD More articles by this author , Jeffrey MullinsJeffrey Mullins Baltimore, MD More articles by this author , Phillip PierorazioPhillip Pierorazio Baltimore, MD More articles by this author , Gautam JayramGautam Jayram Baltimore, MD More articles by this author , Jason CohenJason Cohen Baltimore, MD More articles by this author , Brian MatlagaBrian Matlaga Baltimore, MD More articles by this author , and Mohamad AllafMohamad Allaf Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3116AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Underutilization of partial compared to radical nephrectomy for renal tumors has been demonstrated in recent population-based analyses. One explanation for this is the learning curve associated with laparoscopic partial nephrectomy. We analyzed state trends in renal surgery and their relationship to the introduction of robotic technology. METHODS The Maryland Health Services Cost Review Commission (HSCRC) database was used to identify patients who underwent radical nephrectomy, partial nephrectomy, or renal ablation from 2000-2011. Utilization trends and associated patient and hospital factors were analyzed using multivariate logistic regression. ICD-9 robotic modifier codes were established in October 2008. RESULTS Of 14,260 patients included, 11,271 (79.0%), 2,622 (18.4%), and 367 (2.6%) underwent radical nephrectomy, partial nephrectomy, and renal ablation, respectively. Partial nephrectomy use increased from 8.6% in 2000 to 27% in 2011. Open radical nephrectomy use decreased by 33% while the utilization of minimally-invasive radical nephrectomy increased by 15%. Robotic-assisted laparoscopic partial nephrectomy use increased from 2008 to 2011, reaching 14% for university and 10% for non-university hospitals (p=0.03) and was associated with increased utilization of partial nephrectomy (OR 9.67, p<0.001). Younger age, male sex, and low patient complexity predicted partial nephrectomy use on overall analysis, while higher hospital volume and university status were predictors only in earlier years. CONCLUSIONS Partial nephrectomy use has increased in Maryland from 2001-2011, and this has been facilitated by robotic technology. Associations with hospital factors declined over time. These data suggest robotic technology may enable surgeons across practice settings to more frequently utilize nephron-sparing surgery. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e678-e679 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Metrics Author Information Hiten Patel Baltimore, MD More articles by this author Jeffrey Mullins Baltimore, MD More articles by this author Phillip Pierorazio Baltimore, MD More articles by this author Gautam Jayram Baltimore, MD More articles by this author Jason Cohen Baltimore, MD More articles by this author Brian Matlaga Baltimore, MD More articles by this author Mohamad Allaf Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...