Contemporary Use of Partial Nephrectomy: are Older Patients with Impaired Kidney Function Being Left behind?

To assess whether patient factors, such as age and preoperative kidney function, were associated with receipt of partial in a national integrated health care system.

We identified patients treated with a radical or partial nephrectomy from 2002-2014 in the Veterans Health Administration. We examined associations among patient age, sex, race/ethnicity, multi-morbidity, baseline kidney function, tumor characteristics and receipt of partial nephrectomy. We estimated the odds of receiving a partial nephrectomy and assessed interactions between covariates and the year of surgery to explore whether patient factors associated with partial nephrectomy changed over time.

In our cohort of 14,186 patients, 4,508 (31.2%) received a partial nephrectomy. Use of partial nephrectomy increased from 17% in 2002, to 32% in 2008, and to 38% in 2014. Patient race/ethnicity, age, tumor stage, and year of surgery were independently associated with receipt of partial nephrectomy. Black veterans had significantly increased odds of receipt of partial nephrectomy, while older patients had significantly reduced odds. Partial nephrectomy utilization increased for all groups over time, but older patients, and patients with worse baseline kidney function showed the least increase in odds of partial nephrectomy.

While the utilization of partial nephrectomy increased for all groups, the greatest increase occurred in the youngest patients and those with the highest baseline kidney function. These trends warrant further investigation to ensure that patients at the highest risk of impaired kidney function are considered for partial nephrectomy whenever possible.

Urology. 2016 Sep 12 [Epub ahead of print]

John T Leppert, Harsha R Mittakanti, I-Chun Thomas, Remy W Lamberts, Geoffrey A Sonn, Benjamin I Chung, Eila C Skinner, Todd H Wagner, Glenn M Chertow, James D Brooks

Department of Urology, Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford Kidney Cancer Research Program, Stanford, CA. Electronic address: ., Department of Urology, Stanford University School of Medicine, Stanford, CA., Department of Urology, Stanford University School of Medicine, Stanford, CA; Stanford Kidney Cancer Research Program, Stanford, CA., Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford Kidney Cancer Research Program, Stanford, CA., Department of Medicine, Stanford University School of Medicine, Stanford, CA; Stanford Kidney Cancer Research Program, Stanford, CA.