Partial Nephrectomy More Likely If Robotic Systems Are Available

Partial nephrectomy for renal cell carcinoma (RCC) is more likely to be performed at hospitals where robotic-assisted surgery is available, new findings suggest.

RCC patients also are more likely to undergo partial nephrectomy at academic medical centers and urban centers.

Using both the Nationwide Inpatient Sample and the American Hospital Association survey from 2006 to 2008, Simon P. Kim, MD, of Yale University in New Haven, Conn., and colleagues identified 4,832 patients who underwent PN and 16,347 who underwent radical nephrectomy (RN) for RCC. In multivariate analysis, patients had a significant 28% greater likelihood of undergoing PN at hospitals with robotic surgical systems compared with hospitals lacking such systems, Dr. Kim's team reported online ahead of print in BJU International.

This relationship was apparent even after adjusting for established hospital level effects such as teaching hospitals and urban centers with high volume, “both of which are strongly associated with the use of PN,” the researchers pointed out.

Patients were 2.8 and 3.7 times more likely to undergo PN at academic centers and urban centers, respectively, compared with non-academic and rural centers. Patients were 10% more likely to undergo PN at American College of Surgeons (ACOS)-designated cancer centers compared with non-ACOS-designated centers.

“Our findings supply clinical information to policy-makers and third party payers about which hospitals and surgeons are adopters of PN as a result of access to robotic-assisted surgery and better understanding of the evidence and clinical practice guidelines,” the authors wrote.

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