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Surgeon preference of surgical approach for partial nephrectomy in patients with baseline chronic kidney disease: a nationwide population-based analysis in the USA

  • Urology - Original Paper
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Abstract

Purpose

To examine trends in utilization of open, laparoscopic and robot-assisted surgical approaches for treatment of patients with chronic kidney disease (CKD) undergoing partial nephrectomy (PN) within the USA.

Methods

We analyzed a weighted sample of 112,117 patients from the Premier administrative dataset who underwent PN for renal mass between 2003 and 2015. Proportions of surgical approach utilization were evaluated by CKD status and further stratified by surgery year and surgeon volume. A multivariate logistic regression model was created to predict receipt of minimally invasive PN.

Results

Seven thousand five hundred and sixty-five (6.7%) patients with CKD were identified. The proportion of CKD patients receiving open PN decreased from 72.4% in 2003–2007 to 36.1% in 2012–2015 (p < 0.001). Although the robot-assisted PN was the dominant surgical approach for both patients with and without CKD in 2012–2015, the proportion receiving open PN was higher in patients with CKD compared to those without CKD (p = 0.018). Multivariate analysis showed that the presence of CKD was independently associated with lower odds of receiving a minimally invasive approach (OR 0.47 for the entire study cohort, OR 0.27 for high volume robot-assisted PN surgeons, and OR 0.51 for recent years, all p < 0.001). These trends remained when CKD stages were evaluated individually.

Conclusion

Patients with CKD undergoing PN were preferentially treated with open surgery despite an overall increase in robot-assisted PN use over the past 13 years. Further studies evaluating surgical outcomes in this population are warranted for determination of optimal approach and construction of evidence-based guidelines.

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Authors and Affiliations

  1. Department of Urology, Stanford University Medical Center, Stanford, CA, USA

    Yash S. Khandwala, In Gab Jeong, Deok Hyun Han, Jae Heon Kim & Benjamin I. Chung

  2. San Diego School of Medicine, University of California, San Diego, CA, USA

    Yash S. Khandwala

  3. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    In Gab Jeong

  4. Department of Urology and Dermatology, Stanford University Medical Center, Stanford, CA, USA

    Shufeng Li

  5. Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA

    Ye Wang

  6. Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Steven L. Chang

Authors
  1. Yash S. Khandwala
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  2. In Gab Jeong
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  3. Deok Hyun Han
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  4. Jae Heon Kim
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  5. Shufeng Li
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  6. Ye Wang
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  7. Steven L. Chang
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  8. Benjamin I. Chung
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Corresponding author

Correspondence to In Gab Jeong.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This study has been approved by the institutional review board and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. IRB waived the mandate for obtaining legally effective informed consent from subjects. No information with the potential to disclose patient identities was included.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Khandwala, Y.S., Jeong, I.G., Han, D.H. et al. Surgeon preference of surgical approach for partial nephrectomy in patients with baseline chronic kidney disease: a nationwide population-based analysis in the USA. Int Urol Nephrol 49, 1921–1927 (2017). https://doi.org/10.1007/s11255-017-1688-6

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  • DOI: https://doi.org/10.1007/s11255-017-1688-6

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