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Evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the American Urologic Association guidelines for the management of clinical T1 renal masses

BACKGROUND: Partial nephrectomy has been underutilized in the United States. We investigated national trends in partial nephrectomy (PN) utilization before and after publication of the American Urological Association (AUA) Practice Guideline for management of the clinical T1 renal mass. METHODS: We...

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Autores principales: Liss, Michael A, Wang, Song, Palazzi, Kerrin, Jabaji, Ramzi, Patel, Nishant, Lee, Hak J, Parsons, J Kellogg, Derweesh, Ithaar H
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289557/
https://www.ncbi.nlm.nih.gov/pubmed/25519922
http://dx.doi.org/10.1186/1471-2490-14-101
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author Liss, Michael A
Wang, Song
Palazzi, Kerrin
Jabaji, Ramzi
Patel, Nishant
Lee, Hak J
Parsons, J Kellogg
Derweesh, Ithaar H
author_facet Liss, Michael A
Wang, Song
Palazzi, Kerrin
Jabaji, Ramzi
Patel, Nishant
Lee, Hak J
Parsons, J Kellogg
Derweesh, Ithaar H
author_sort Liss, Michael A
collection PubMed
description BACKGROUND: Partial nephrectomy has been underutilized in the United States. We investigated national trends in partial nephrectomy (PN) utilization before and after publication of the American Urological Association (AUA) Practice Guideline for management of the clinical T1 renal mass. METHODS: We identified adult patients who underwent radical (RN) or PN from November 2007 to October 2011 in the Nationwide Inpatient Sample (NIS). PN prevalence was calculated prior to (11/2007-10/2009) and after Guidelines publication (11/2009-10/2011) and compared the rate of change by linear regression. We also examined the nephrectomy trends in patients with chronic kidney disease (CKD). Statistical analysis included linear regression to determine point-prevalence of PN rates in CKD patients and logistic regression to identify variables associated with PN. RESULTS: During the study period, 30,944 patients underwent PN and 64,767 RN. The prevalence PN increased from 28.9% in the years prior to guideline release to 35.3% in the years following guideline release with an adjusted odds ratio (OR) of 1.24 (CI 1.01–1.54; p = 0.049). The rate of PN significantly increased throughout the study period (R(2) 0.15, p = 0.006): however, the rate of change was not increased after the guidelines. (p = 0.46). Overall rate of PN in patients with CKD did not increase over time (R(2) 0.0007, p = 0.99). CONCLUSION: We noted a 6.4% absolute increase in PN after release of the AUA guidelines on clinical T1 renal mass was published; however, the rate of increase was not likely associated with guideline release. The rate of PN performed is increasing; however, further investigation regarding medical decision-making surrounding PN is needed.
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spelling pubmed-42895572015-01-12 Evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the American Urologic Association guidelines for the management of clinical T1 renal masses Liss, Michael A Wang, Song Palazzi, Kerrin Jabaji, Ramzi Patel, Nishant Lee, Hak J Parsons, J Kellogg Derweesh, Ithaar H BMC Urol Research Article BACKGROUND: Partial nephrectomy has been underutilized in the United States. We investigated national trends in partial nephrectomy (PN) utilization before and after publication of the American Urological Association (AUA) Practice Guideline for management of the clinical T1 renal mass. METHODS: We identified adult patients who underwent radical (RN) or PN from November 2007 to October 2011 in the Nationwide Inpatient Sample (NIS). PN prevalence was calculated prior to (11/2007-10/2009) and after Guidelines publication (11/2009-10/2011) and compared the rate of change by linear regression. We also examined the nephrectomy trends in patients with chronic kidney disease (CKD). Statistical analysis included linear regression to determine point-prevalence of PN rates in CKD patients and logistic regression to identify variables associated with PN. RESULTS: During the study period, 30,944 patients underwent PN and 64,767 RN. The prevalence PN increased from 28.9% in the years prior to guideline release to 35.3% in the years following guideline release with an adjusted odds ratio (OR) of 1.24 (CI 1.01–1.54; p = 0.049). The rate of PN significantly increased throughout the study period (R(2) 0.15, p = 0.006): however, the rate of change was not increased after the guidelines. (p = 0.46). Overall rate of PN in patients with CKD did not increase over time (R(2) 0.0007, p = 0.99). CONCLUSION: We noted a 6.4% absolute increase in PN after release of the AUA guidelines on clinical T1 renal mass was published; however, the rate of increase was not likely associated with guideline release. The rate of PN performed is increasing; however, further investigation regarding medical decision-making surrounding PN is needed. BioMed Central 2014-12-17 /pmc/articles/PMC4289557/ /pubmed/25519922 http://dx.doi.org/10.1186/1471-2490-14-101 Text en © Liss et al.; licensee BioMed Central. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Liss, Michael A
Wang, Song
Palazzi, Kerrin
Jabaji, Ramzi
Patel, Nishant
Lee, Hak J
Parsons, J Kellogg
Derweesh, Ithaar H
Evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the American Urologic Association guidelines for the management of clinical T1 renal masses
title Evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the American Urologic Association guidelines for the management of clinical T1 renal masses
title_full Evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the American Urologic Association guidelines for the management of clinical T1 renal masses
title_fullStr Evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the American Urologic Association guidelines for the management of clinical T1 renal masses
title_full_unstemmed Evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the American Urologic Association guidelines for the management of clinical T1 renal masses
title_short Evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the American Urologic Association guidelines for the management of clinical T1 renal masses
title_sort evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the american urologic association guidelines for the management of clinical t1 renal masses
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289557/
https://www.ncbi.nlm.nih.gov/pubmed/25519922
http://dx.doi.org/10.1186/1471-2490-14-101
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