Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan.
Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan.
J Urol. 2014 Mar;191(3):764-70. doi: 10.1016/j.juro.2013.09.063. Epub 2013 Oct 3.
There is a paucity of knowledge regarding nephrectomy in contemporary United States pediatric populations. Usage patterns, indications and demographics of children undergoing nephrectomy are unknown. Given the significant increases in the use of minimally invasive nephrectomy in adults, we hypothesized similar trends may be seen in the pediatric population.
An estimated total of 27,615 children undergoing nephrectomy between 1998 and 2010 was extracted from the Nationwide Inpatient Sample. Trends in use were analyzed with the estimated annual percent change methodology using linear regression and proportions by chi-square. Determinants of minimally invasive nephrectomy were evaluated using generalized linear models adjusted for clustering with generalized estimating equations.
The annual incidence of pediatric nephrectomy was 2.90 per 100,000 patient-years and remained stable. Nephrectomy was most common in children 0 to 1 year old (36%) and least common in children 6 to 9 years old (14%). However, nephrectomy for malignancy was most common in children 3 to 4 years old. Minimally invasive nephrectomy usage increased from 1.1% to 11.6% during the study period (estimated annual percent change 72.82%, p = 0.007). On multivariable analysis patients with malignancy (OR 0.07, p <0.001) had a lower rate of minimally invasive nephrectomy. Increased use was associated with increasing age (OR 1.07, p <0.001), treatment at a teaching institution (OR 1.95, p = 0.008) and increasing hospital volume (OR 1.01, p = 0.001).
While the annual incidence of nephrectomy is stable, the use of minimally invasive nephrectomy is expanding in the pediatric population. Benign pathology and increasing age as well as nephrectomy at high volume teaching institutions are independently associated with minimally invasive nephrectomy use.
目前关于当代美国儿科人群肾切除术的知识还很匮乏。行肾切除术患儿的使用模式、适应证和人口统计学特征尚不清楚。鉴于成人微创肾切除术的使用显著增加，我们假设在儿科人群中也可能出现类似的趋势。
从 1998 年至 2010 年，从全国住院患者样本中提取了 27615 名接受肾切除术的儿童的估计总数。使用线性回归和 χ2 检验的比例，采用估计年度百分比变化方法分析使用趋势。使用广义线性模型评估微创肾切除术的决定因素，并使用广义估计方程进行聚类调整。
儿童肾切除术的年发病率为每 100000 患者 2.90 例，且保持稳定。肾切除术最常见于 0 至 1 岁的儿童（36%），最不常见于 6 至 9 岁的儿童（14%）。然而，恶性肿瘤的肾切除术最常见于 3 至 4 岁的儿童。在研究期间，微创肾切除术的使用率从 1.1%增加到 11.6%（估计的年百分比变化 72.82%，p=0.007）。多变量分析显示，恶性肿瘤患者（OR 0.07，p<0.001）微创肾切除术的比率较低。使用率的增加与年龄的增加（OR 1.07，p<0.001）、在教学机构治疗（OR 1.95，p=0.008）和医院容量的增加（OR 1.01，p=0.001）有关。
虽然肾切除术的年发病率保持稳定，但微创肾切除术在儿科人群中的使用正在扩大。良性病变和年龄的增加以及在高容量教学医院行肾切除术与微创肾切除术的使用独立相关。
