425 REGIONALIZATION OF RENAL SURGERY IMPACT OF HOSPITAL VOLUME ON UTILIZATION OF PARTIAL NEPHRECTOMY (2012)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness III1 Apr 2012425 REGIONALIZATION OF RENAL SURGERY IMPACT OF HOSPITAL VOLUME ON UTILIZATION OF PARTIAL NEPHRECTOMY Marc Smaldone, Jay Simhan, Daniel Canter, Russell Starkey, Fang Zhu, Karyn Stitzenberg, Alexander Kutikov, and Robert Uzzo Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author , Jay SimhanJay Simhan Philadelphia, PA More articles by this author , Daniel CanterDaniel Canter Atlanta, GA More articles by this author , Russell StarkeyRussell Starkey Philadelphia, PA More articles by this author , Fang ZhuFang Zhu Philadelphia, PA More articles by this author , Karyn StitzenbergKaryn Stitzenberg Chapel Hill, NC More articles by this author , Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author , and Robert UzzoRobert Uzzo Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.491AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In an effort the reduce the risk of chronic kidney disease and it’s attendant cardiovascular and mortality risks, the AUA guidelines recommend nephron sparing surgery for all localized lesions amenable to partial nephrectomy (PN). The purpose of this study was to investigate trends in regionalization of care for surgical management of renal cell carcinoma (RCC). METHODS Using 1996 to 2009 hospital discharge data from NY, NJ, and PA, patients undergoing surgery for RCC were identified using ICD-9 coding. We assigned hospital volume status by quintiles based on relative proportions of renal procedures (radical nephrectomy (RN), partial nephrectomy (PN), ablation(ABL)) performed on a per hospital basis in 1996; very low volume hospital: 0-6 (VLVH), low: 7-12 (LVH), moderate: 13-20 (MVH), high: 21-46 (HVH) and very high volume hospital: ≥47 (VHVH). Patient characteristics were compared between groups and procedure performance by hospital volume status was assessed over time using regression models. RESULTS Of 57,886 patients identified, there was a significant shift towards regionalization for total renal procedures to VHVHs (18 to 48%, p<0.001) from 1996 to 2009. Patients treated at a VHVH were less likely to be older (ages 65-74 (OR 0.89 [CI 0.82-0.96]); 75-84 (OR 0.89 [CI 0.84-0.96]), have Medicaid (OR 0.68 [0.50-0.91]), Medicare (OR 0.88 [0.82-0.94]), or be uninsured (OR 0.39 [CI 0.30-0.51]). Over the duration of the study period, PN treatment increased from 8.3% (1996) to 35.4% (2009). Controlling for year treated and number of procedures performed, utilization of RN significantly decreased across all volume strata when compared to VLVH (all p values <0.001), while trends in use of ABL were less affected by volume status. A significant trend towards increased utilization of PN was observed with increasing volume status; LVH (OR 1.3 [CI 1.1-1.6]), MVH (OR 1.7 [CI 1.5-1.9]), HVH (OR 2.2 [CI 1.9-2.5]), VHVH (OR 4.3 [CI 4.0-4.6]). CONCLUSIONS While increasing overall, performance of PN has shifted markedly to higher volume hospitals from 1996 to 2009. Inequities in access to care exist and must be addressed in future studies. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e174-e175 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marc Smaldone Philadelphia, PA More articles by this author Jay Simhan Philadelphia, PA More articles by this author Daniel Canter Atlanta, GA More articles by this author Russell Starkey Philadelphia, PA More articles by this author Fang Zhu Philadelphia, PA More articles by this author Karyn Stitzenberg Chapel Hill, NC More articles by this author Alexander Kutikov Philadelphia, PA More articles by this author Robert Uzzo Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...