Skip to main content
SpringerLink
Log in

Does partial nephrectomy at an academic institution result in better outcomes?

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Partial nephrectomy (PN) outcomes may be better at academic institutions than at non-academic centers. Peer-review, sub-specialized practice profile, higher individual surgeon and institutional caseload may explain this observation. To the best of our knowledge, the role of institutional academic affiliation has not been examined with regard to PN postoperative outcomes.

Methods

Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on PNs performed within the 10 most contemporary years (1998–2007). We explored the effect of academic status on three short-term PN outcomes (intraoperative and postoperative complications, as well as in-hospital mortality). Multivariable logistic regression analyses further adjusted for age, race, gender, Charlson Comorbidity Index (CCI), surgical approach, hospital region, annual hospital caseload and insurance status.

Results

Overall, 8,513 PNs were identified. Of those, 5,906 (69.4%) were recorded at academic institutions. Academic institution patients had lower CCI, were less frequently Caucasian and more frequently had private insurance (all P < 0.001). Academic institution PNs were associated with fewer postoperative complications (14.6% vs. 16.6%, P = 0.018). In multivariable analyses, institutional academic status did not affect the three short-term PN outcomes.

Conclusions

Patient selection explains better PN postoperative outcomes at academic institutions. Control for these biases removes the outcome differences, at least when the three short-term PN outcomes are considered. However, the interpretation of these findings needs to take into account the lack of adjustment for case complexity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, Faraday MM, Kaouk JH, Leveillee RJ, Matin SF, Russo P, Uzzo RG (2009) Guideline for management of the clinical T1 renal mass. J Urol 182(4):1271–1279. doi:10.1016/j.juro.2009.07.004

    Article  PubMed  Google Scholar 

  2. Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, Scardino PT, Russo P (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7(9):735–740. doi:10.1016/S1470-2045(06)70803-8

    Article  PubMed  Google Scholar 

  3. Lee CT, Katz J, Shi W, Thaler HT, Reuter VE, Russo P (2000) Surgical management of renal tumors 4 cm. or less in a contemporary cohort. J Urol 163(3):730–736

    Article  PubMed  CAS  Google Scholar 

  4. Patard JJ, Shvarts O, Lam JS, Pantuck AJ, Kim HL, Ficarra V, Cindolo L, Han KR, De La Taille A, Tostain J, Artibani W, Abbou CC, Lobel B, Chopin DK, Figlin RA, Mulders PF, Belldegrun AS (2004) Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol 171(6 Pt 1):2181–2185 (quiz 2435)

    Article  PubMed  Google Scholar 

  5. Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Colombel M, Klotz L, Skinner E, Keane T, Marreaud S, Collette S, Sylvester R (2011) A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 59(4):543–552. doi:10.1016/j.eururo.2010.12.013

    Article  PubMed  Google Scholar 

  6. Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137. doi:10.1056/NEJMsa012337

    Article  PubMed  Google Scholar 

  7. Begg CB, Cramer LD, Hoskins WJ, Brennan MF (1998) Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280(20):1747–1751

    Article  PubMed  CAS  Google Scholar 

  8. Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A (2000) Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 283(9):1159–1166

    Article  PubMed  CAS  Google Scholar 

  9. Joudi FN, Allareddy V, Kane CJ, Konety BR (2007) Analysis of complications following partial and total nephrectomy for renal cancer in a population based sample. J Urol 177(5):1709–1714. doi:10.1016/j.juro.2007.01.037

    Article  PubMed  Google Scholar 

  10. Corman JM, Penson DF, Hur K, Khuri SF, Daley J, Henderson W, Krieger JN (2000) Comparison of complications after radical and partial nephrectomy: results from the National Veterans Administration Surgical Quality Improvement Program. BJU Int 86(7):782–789

    Article  PubMed  CAS  Google Scholar 

  11. Charlson M, Pompei P, Ales K, MacKenzie C (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  PubMed  CAS  Google Scholar 

  12. Deyo R, Cherkin D, Ciol M (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619

    Article  PubMed  CAS  Google Scholar 

  13. United States Census Bureau (2000) http://www.census.gov. 2010

  14. NIS Database Documentation—Description of Data Elements; May 2011. Available at: http://www.hcup-us.ahrq.gov/db/nation/nis/nisdde.jsp. Accessed 13 July 2011

  15. D’Agostino RB (1998) Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Statist Med 17(19):2265–2281

    Article  Google Scholar 

  16. Stukel TA, Fisher ES, Wennberg DE, Alter DA, Gottlieb DJ, Vermeulen MJ (2007) Analysis of observational studies in the presence of treatment selection bias: effects of invasive cardiac management on AMI survival using propensity score and instrumental variable methods. JAMA 297(3):278–285. doi:10.1001/jama.297.3.278

    Article  PubMed  CAS  Google Scholar 

  17. Hollingsworth JM, Krein SL, Dunn RL, Wolf JS Jr, Hollenbeck BK (2008) Understanding variation in the adoption of a new technology in surgery. Med Care 46(4):366–371. doi:10.1097/MLR.0b013e31815dc5c0

    Article  PubMed  Google Scholar 

  18. Rosenthal GE, Harper DL, Quinn LM, Cooper GS (1997) Severity-adjusted mortality and length of stay in teaching and nonteaching hospitals. Results of a regional study. JAMA 278(6):485–490

    Article  PubMed  CAS  Google Scholar 

  19. Allison JJ, Kiefe CI, Weissman NW, Person SD, Rousculp M, Canto JG, Bae S, Williams OD, Farmer R, Centor RM (2000) Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI. JAMA 284(10):1256–1262

    Article  PubMed  CAS  Google Scholar 

  20. Patel MR, Chen AY, Roe MT, Ohman EM, Newby LK, Harrington RA, Smith SC Jr, Gibler WB, Calvin JE, Peterson ED (2007) A comparison of acute coronary syndrome care at academic and nonacademic hospitals. Am J Med 120(1):40–46. doi:10.1016/j.amjmed.2006.10.008

    Article  PubMed  Google Scholar 

  21. Kupersmith J (2005) Quality of care in teaching hospitals: a literature review. Acad Med 80(5):458–466

    Article  PubMed  Google Scholar 

  22. Polanczyk CA, Lane A, Coburn M, Philbin EF, Dec GW, DiSalvo TG (2002) Hospital outcomes in major teaching, minor teaching, and nonteaching hospitals in New York state. Am J Med 112(4):255–261

    Article  PubMed  Google Scholar 

  23. Dimick JB, Cowan JA Jr, Colletti LM, Upchurch GR Jr (2004) Hospital teaching status and outcomes of complex surgical procedures in the United States. Arch Surg 139(2):137–141. doi:10.1001/archsurg.139.2.137

    Article  PubMed  Google Scholar 

  24. Keeler EB, Rubenstein LV, Kahn KL, Draper D, Harrison ER, McGinty MJ, Rogers WH, Brook RH (1992) Hospital characteristics and quality of care. JAMA 268(13):1709–1714

    Article  PubMed  CAS  Google Scholar 

  25. Meguid RA, Brooke BS, Perler BA, Freischlag JA (2009) Impact of hospital teaching status on survival from ruptured abdominal aortic aneurysm repair. J Vasc Surg 50(2):243–250. doi:10.1016/j.jvs.2009.01.046

    Article  PubMed  Google Scholar 

  26. Trinh QD, Schmitges J, Sun M, Shariat SF, Sukumar S, Bianchi M, Tian Z, Jeldres C, Sammon J, Perrotte P, Graefen M, Peabody J, Menon M, Karakiewicz PI (2011) Radical prostatectomy at academic vs. non-academic institutions: a population-based analysis. J Urol (in press)

  27. Ayanian JZ, Weissman JS, Chasan-Taber S, Epstein AM (1998) Quality of care for two common illnesses in teaching and nonteaching hospitals. Health Aff (Millwood) 17(6):194–205

    Article  CAS  Google Scholar 

Download references

Acknowledgments

Pierre I. Karakiewicz is partially supported by the University of Montreal Health Centre Urology Specialists, Fonds de la Recherche en Sante du Quebec, the University of Montreal Department of Surgery and the University of Montreal Health Centre (CHUM) Foundation. Jan Schmitges is supported by the German Federal Ministry of Education and Science in the framework of the program for medical genome research FKZ:01GS08189.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA

    Quoc-Dien Trinh, Jesse Sammon, Shyam Sukumar, Craig G. Rogers, James O. Peabody & Mani Menon

  2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal, QC, H2X 3J4, Canada

    Quoc-Dien Trinh, Jan Schmitges, Maxine Sun, Kevin Zorn, Marco Bianchi, Claudio Jeldres, Paul Perrotte & Pierre I. Karakiewicz

  3. Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany

    Jan Schmitges & Markus Graefen

  4. Department of Urology, Weill Medical College of Cornell University, New York, NY, USA

    Shahrokh F. Shariat

  5. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Markus Graefen

Authors
  1. Quoc-Dien Trinh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan Schmitges
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maxine Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jesse Sammon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shahrokh F. Shariat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shyam Sukumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kevin Zorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marco Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Claudio Jeldres
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Paul Perrotte
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Markus Graefen
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Craig G. Rogers
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. James O. Peabody
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Mani Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Pierre I. Karakiewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Quoc-Dien Trinh.

Additional information

Quoc-Dien Trinh and Jan Schmitges contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Trinh, QD., Schmitges, J., Sun, M. et al. Does partial nephrectomy at an academic institution result in better outcomes?. World J Urol 30, 505–510 (2012). https://doi.org/10.1007/s00345-011-0759-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-011-0759-z

Keywords

Search

Navigation