Development of a Novel Scoring System Quantifies Opportunities to Reduce Surgery for Benign Renal Neoplasms: A Retrospective Quality Improvement Analysis within the MUSIC KIDNEY Collaborative.

Non-malignant pathology (NMP) has been reported in 15-20% of surgeries for cT1 renal masses (cT1RM). We seek to identify opportunities for improvement in avoiding surgery for NMP.

MUSIC-KIDNEY started collecting data in 2017. All cT1RM patients who had partial (PN) or radical (RN) nephrectomy for NMP were identified. Category for improvement (none=0, minor=1, moderate=2, or major=3) was independently assigned to each case by five experienced kidney surgeons. Specific strategies to decrease NMP were identified.

Of 1392 patients with cT1RM, 653 underwent surgery and 74 had NMP (11%). Of these, 23 (31%) were cT1b. RN was performed in 17 (22.9%) patients for 5 cT1a and 12 cT1b lesions. Only 6 patients had a biopsy prior to surgery (5 oncocytoma, 1 unclassified RCC). Review identified 25 cases with minor (34%), 26 with moderate (35%), and 10 with major (14%) QI opportunities. 17% of cases had no QI opportunities identified (12 PN, 1 RN).

Review of cT1RM patients who underwent surgery for NMP revealed a significant number of cases in which this outcome may have been avoided. Approximately half of cases had moderate or major QI opportunities, with RN for NMP being the most common reason. Our data indicate a lowest achievable and "acceptable" rate of NMP to be 1.9% and 5.4% respectively. Avoiding interventions for NMP, particularly RN, is an important focus of QI efforts. Strategies to decrease unnecessary interventions for NMP include greater use of repeat imaging, renal mass biopsy, and surveillance.

The Journal of urology. 2020 Jul 06 [Epub ahead of print]

Henry Peabody, Amit Patel, Anna Johnson, Mahin Mirza, Sabrina L Noyes, Edward Schervish, Sanjeev Kaul, Craig G Rogers, Brian R Lane, Alice Semerjian

Spectrum Health Hospital System, Grand Rapids, Michigan., Henry Ford Health System, Detroit, Michigan., Michigan Medicine, Ann Arbor, Michigan., Michigan Institute of Urology, St. Clair Shores, Michigan., Comprehensive Urology, William Beaumont Hospital, Royal Oak, Michigan., IHA Urology, St. Joseph Mercy Hospital, Ann Arbor, Michigan.