Liss Michael A, Wang Song, Palazzi Kerrin, Jabaji Ramzi, Patel Nishant, Lee Hak J, Parsons J Kellogg, Derweesh Ithaar H
Department of Urology, University of California San Diego Health System, La Jolla, CA, USA.
BMC Urol. 2014 Dec 17;14:101. doi: 10.1186/1471-2490-14-101.
Partial nephrectomy has been underutilized in the United States. We investigated national trends in partial nephrectomy (PN) utilization before and after publication of the American Urological Association (AUA) Practice Guideline for management of the clinical T1 renal mass.
We identified adult patients who underwent radical (RN) or PN from November 2007 to October 2011 in the Nationwide Inpatient Sample (NIS). PN prevalence was calculated prior to (11/2007-10/2009) and after Guidelines publication (11/2009-10/2011) and compared the rate of change by linear regression. We also examined the nephrectomy trends in patients with chronic kidney disease (CKD). Statistical analysis included linear regression to determine point-prevalence of PN rates in CKD patients and logistic regression to identify variables associated with PN.
During the study period, 30,944 patients underwent PN and 64,767 RN. The prevalence PN increased from 28.9% in the years prior to guideline release to 35.3% in the years following guideline release with an adjusted odds ratio (OR) of 1.24 (CI 1.01-1.54; p = 0.049). The rate of PN significantly increased throughout the study period (R2 0.15, p = 0.006): however, the rate of change was not increased after the guidelines. (p = 0.46). Overall rate of PN in patients with CKD did not increase over time (R2 0.0007, p = 0.99).
We noted a 6.4% absolute increase in PN after release of the AUA guidelines on clinical T1 renal mass was published; however, the rate of increase was not likely associated with guideline release. The rate of PN performed is increasing; however, further investigation regarding medical decision-making surrounding PN is needed.
在美国，部分肾切除术的应用未得到充分利用。我们调查了美国泌尿外科学会（AUA）关于临床T1期肾肿块管理的实践指南发布前后部分肾切除术（PN）的全国使用趋势。
我们在全国住院患者样本（NIS）中确定了2007年11月至2011年10月期间接受根治性肾切除术（RN）或PN的成年患者。计算指南发布前（2007年11月至2009年10月）和发布后（2009年11月至2011年10月）的PN患病率，并通过线性回归比较变化率。我们还研究了慢性肾脏病（CKD）患者的肾切除术趋势。统计分析包括线性回归以确定CKD患者中PN率的点患病率，以及逻辑回归以识别与PN相关的变量。
在研究期间，30944例患者接受了PN，64767例接受了RN。指南发布前几年的PN患病率从28.9%增加到指南发布后几年的35.3%，调整后的优势比（OR）为1.24（CI 1.01-1.54；p = 0.049）。在整个研究期间，PN率显著增加（R2 0.15，p = 0.006）；然而，指南发布后变化率并未增加（p = 0.46）。CKD患者的总体PN率并未随时间增加（R2 0.0007，p = 0.99）。
我们注意到AUA关于临床T1期肾肿块的指南发布后，PN绝对增加了6.4%；然而，增加率不太可能与指南发布有关。PN的实施率正在上升；然而，需要对围绕PN的医疗决策进行进一步调查。
