Miller David C, Shah Rajal B, Bruhn Aron, Madison Rodger, Saigal Christopher S
Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
J Urol. 2008 Feb;179(2):461-7; discussion 467. doi: 10.1016/j.juro.2007.09.041.
There is no consensus regarding the role of intraoperative pathological consultation during kidney cancer surgery. Accordingly intraoperative pathological consultation use is susceptible to variation based on nonclinical factors. We explored this hypothesis by evaluating national trends in the use of intraoperative pathological consultation during radical or partial nephrectomy with time, across regions, and by patient and provider characteristics.
Using linked Surveillance, Epidemiology and End Results-Medicare data we identified a cohort of patients who underwent partial or radical nephrectomy from 1991 to 2002. In each case we ascertained corresponding Medicare claims for gross and/or frozen section intraoperative pathological consultation. We assessed variations in the use of intraoperative pathological consultation by year of treatment and geographic region as well as by patient and provider characteristics.
We identified 7,507 cases treated with partial (600 or 8.0%) or radical (6,907 or 92.0%) nephrectomy from 1991 through 2002. Of cases treated with radical nephrectomy 744 (10.8%) and 843 (12.2%) received gross and frozen section intraoperative pathological consultation, respectively. Of cases treated with partial nephrectomy 67 (11.2%) had an intraoperative gross consultation and 323 (53.8%) had a frozen section evaluation. Use of intraoperative pathological consultation (gross or frozen section) during partial and radical nephrectomy varied based on patient demographics, United States Census region, and Surveillance, Epidemiology and End Results registry (p <0.05). Intraoperative pathological consultation during radical nephrectomy differed by year of treatment (p <0.05). Intraoperative pathological consultation use also varied based on provider characteristics (p <0.05).
Intraoperative pathological consultation use during kidney cancer surgery varies with time, across geographic regions and based on patient demographics and broadly defined provider characteristics. These data provide context for future studies seeking to refine the use of intraoperative pathological consultation in this clinical setting.
关于术中病理会诊在肾癌手术中的作用尚无共识。因此，术中病理会诊的使用容易因非临床因素而有所不同。我们通过评估根治性或部分肾切除术中术中病理会诊使用情况随时间、地区以及患者和医疗服务提供者特征的全国趋势，对这一假设进行了探究。
利用关联的监测、流行病学和最终结果-医疗保险数据，我们确定了一组在1991年至2002年期间接受部分或根治性肾切除术的患者。对于每一例患者，我们确定了相应的关于大体和/或冰冻切片术中病理会诊的医疗保险索赔。我们评估了术中病理会诊使用情况在治疗年份、地理区域以及患者和医疗服务提供者特征方面的差异。
我们确定了1991年至2002年期间接受部分（600例或8.0%）或根治性（6907例或92.0%）肾切除术的7507例病例。在接受根治性肾切除术的病例中，分别有744例（10.8%）和843例（12.2%）接受了大体和冰冻切片术中病理会诊。在接受部分肾切除术的病例中，67例（11.2%）进行了术中大体会诊，323例（53.8%）进行了冰冻切片评估。部分和根治性肾切除术中术中病理会诊（大体或冰冻切片）的使用因患者人口统计学特征、美国人口普查区域以及监测、流行病学和最终结果登记处而异（p<0.05）。根治性肾切除术中术中病理会诊因治疗年份而异（p<0.05）。术中病理会诊的使用也因医疗服务提供者特征而异（p<0.05）。
肾癌手术中术中病理会诊的使用随时间、地理区域以及患者人口统计学特征和广义定义的医疗服务提供者特征而变化。这些数据为未来旨在优化这种临床情况下术中病理会诊使用的研究提供了背景信息。
