AUA 2018: Trends in Renal Surgery from the National Inpatient Sample: Implications for Resident Education

San Francisco, CA USA (UroToday.com) In accordance with the increased diagnosis of renal cancer in the past two decades, urologists have become more comfortable with minimally invasive surgery. However, there is yet no established impact of these observations on resident exposure and case mix. The objective of this study was to examine trends in utilization of open and minimally invasive approaches for radical and partial nephrectomies, in training and nonteaching institutions.

ICD-9 codes from the National Inpatient Sample, from 2001 to 2013, were used to collect data for a retrospective cross sectional analysis. A total of 106,721 radical nephrectomies were performed during the study period. Of this total, 87,951 were open, 15,105 were laparoscopic, and 3,665 were robotic. Additionally, a total of 29,370 partial nephrectomies were performed, of which 20,532 were open, 2,056 were laparoscopic, and 6,782 were robotic.

Looking at nationwide data this study found that a proportion of open radical and partial nephrectomies had decreased over time (6098 to 5710 cases) and the proportion of robotic cases had increased, while pure laparoscopic cases had remained relatively stable. Interestingly, though, looking at teaching hospitals, there was an increase in the overall number of open (3400 cases 55.8% to 3977 cases 69.6%), laparoscopic, and robotic radical and partial nephrectomies performed over this time interval. In stratifying both cases by teaching and nonteaching hospitals, the proportion of open radical and partial nephrectomies had increased over time at teaching hospitals in comparison to decreasing trends in nonteaching hospitals. The number of open partial nephrectomies increased from 793 to 1515 overall, and at urban teaching hospitals cases increased from 449 (62.9%) to 1100 (72.6%). Moreover, 2,543 (69.3%) of the 3,665 robotic radical nephrectomies performed were at urban teaching hospitals, while 1,007 (27.5%) were at urban non-teaching hospitals, and 115 (3.1%) were at rural hospitals. Of the 6,782 robotic partial nephrectomies performed 5014 (73.9%) were at urban teaching hospitals, 1643 (24.2%) were at urban non-teaching hospitals, and 125 (1.8%) were at rural hospitals.

Researchers concludes that while minimally invasive approaches have been increasing, open renal surgery still represents a larger proportion of the cases being performed at teaching institutions. One member of the audience made note on how the study has a tremendous amount of implications on training and its somewhat comforting to see that open nephrectomies still exist. However, it was found surprising that open radical nephrectomies are increasing and this raises the question of what type of complex tumors are being dealt with that require for physicians from teaching hospitals to be referred. One future direction can be to assess the tumor complexity of this dataset to further gain insight on the trends of open and minimally invasive approaches for radical and partial nephrectomies, in training and nonteaching institutions.

Presented by: Joseph Riney, MD

Written by: Rita Derderian, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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