Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan 48202, USA.
J Urol. 2012 Sep;188(3):913-8. doi: 10.1016/j.juro.2012.05.013. Epub 2012 Jul 20.
Minimally invasive pyeloplasty might have several advantages compared to open pyeloplasty in the management of ureteropelvic junction obstruction. Nonetheless, minimally invasive pyeloplasty appears to be underused in North America. We examined specific patient and hospital characteristics that may be associated with these disparities.
The Nationwide Inpatient Sample was used to identify a national estimate of 29,456 patients with ureteropelvic junction obstruction treated with minimally invasive pyeloplasty (laparoscopic or robotic) and open pyeloplasty between 1998 and 2009. The rates of use of minimally invasive and open pyeloplasty were assessed according to year of surgery, and patient and hospital characteristics. The determinants of minimally invasive pyeloplasty were evaluated using logistic regression models adjusted for clustering.
Overall 15.3% of patients underwent minimally invasive pyeloplasty between 1998 and 2009. The use of minimally invasive pyeloplasty increased remarkably during the study period from 2.4% to 55.3%, a 23-fold increase. On multivariable logistic regression analysis African-American race (OR 0.584, p = 0.015) and other insurance status (including uninsured patients, OR 0.613, p = 0.013) were associated with a lower rate of minimally invasive pyeloplasty. Patients treated at teaching (OR 1.788, p = 0.003) and/or urban (OR 4.819, p <0.001) institutions were significantly more likely to undergo minimally invasive pyeloplasty.
In the last decade there has been a dramatic increase in the use of minimally invasive pyeloplasty in the United States and in 2009 a slight majority underwent minimally invasive pyeloplasty. Nonetheless, treatment disparities exist. African-American patients with other insurance status (including those uninsured) treated at nonteaching, rural hospitals were less likely to undergo minimally invasive pyeloplasty. Efforts should be made to understand these treatment disparities and broaden the availability of minimally invasive pyeloplasty.
与开放肾盂成形术相比，微创肾盂成形术在治疗肾盂输尿管连接部梗阻方面可能具有多种优势。然而，微创肾盂成形术在北美的应用似乎不足。我们研究了可能与这些差异相关的特定患者和医院特征。
使用全国住院患者样本，确定了 1998 年至 2009 年间 29456 例接受微创肾盂成形术（腹腔镜或机器人）和开放肾盂成形术治疗的肾盂输尿管连接部梗阻患者的全国估计值。根据手术年份评估微创和开放肾盂成形术的使用率，并评估患者和医院特征。使用逻辑回归模型评估微创肾盂成形术的决定因素，并对聚类进行调整。
1998 年至 2009 年，总体上有 15.3%的患者接受了微创肾盂成形术。在研究期间，微创肾盂成形术的使用率显著增加，从 2.4%增加到 55.3%，增加了 23 倍。多元逻辑回归分析显示，非裔美国人种族（OR 0.584，p = 0.015）和其他保险状态（包括未参保患者，OR 0.613，p = 0.013）与微创肾盂成形术的低使用率相关。在教学（OR 1.788，p = 0.003）和/或城市（OR 4.819，p <0.001）机构接受治疗的患者更有可能接受微创肾盂成形术。
在过去十年中，美国微创肾盂成形术的使用率显著增加，2009 年微创肾盂成形术的使用率略高于开放肾盂成形术。尽管如此，治疗差异仍然存在。非裔美国患者和其他保险状态（包括未参保患者）在非教学、农村医院接受治疗的患者接受微创肾盂成形术的可能性较低。应努力了解这些治疗差异，并扩大微创肾盂成形术的应用。
