Trends in renal cancer surgery and patient provider characteristics associated with partial nephrectomy in the United States

ObjectiveMany renal tumors are amenable to either partial or total nephrectomy, but little is known about the relative frequency that these procedures are performed in the United States. We describe recent temporal trends in surgery for renal neoplasm and identified factors associated with partial nephrectomy.MethodsData from the 1998 through 2002 National Inpatient Sample was analyzed to identify adult patients discharged after renal cancer surgery. The frequency of partial and total nephrectomy in the United States was estimated, and multivariate regression was used to examine patient and provider factors associated with partial nephrectomy.ResultsThe number of nephrectomies performed for tumor in the United States increased yearly, with an estimated 23,375 total nephrectomies and 4272 partial nephrectomies performed in 2002. The ratio of partial nephrectomies to total nephrectomies also increased (P < 0.001), with partial nephrectomy representing 15.5% of all nephrectomies in 2002. In the multivariate analysis, patient and provider factors significantly associated with undergoing partial nephrectomy included female sex (odds ratio [OR] = 0.86, 95% confidence interval [CI] 0.79–0.94), age (OR = 0.38, 95% CI 0.30–0.49 comparing age older than 79 to younger than 40 years), teaching hospital status (OR = 1.54, 95% CI 1.34–1.76), annual hospital nephrectomy volume (OR = 1.96, 95% CI 1.62–2.39 comparing highest to lowest quartiles), annual surgeon nephrectomy volume (OR = 2.60, 95% CI 2.12–3.20 comparing highest to lowest quartiles), and private insurance/health maintenance organization coverage (OR = 1.25, 95% CI 1.11–1.40 compared to Medicare).ConclusionsThe total number of nephrectomies and the proportion of partial nephrectomies performed in the United States increased yearly from 1998 to 2002. Male sex, hospital teaching status, higher hospital and surgeon volume, and insurance status are associated with receiving partial nephrectomy.