Department of Urology, Rush University Medical Center, Chicago, IL, USA.
Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy.
Ann Surg Oncol. 2024 Oct;31(10):7212-7219. doi: 10.1245/s10434-024-15565-6. Epub 2024 Jun 15.
It is generally perceived that minimally invasive nephroureterectomy (MINU), especially in the form of robotic-assisted laparoscopy, is gaining an increasing role in many institutions.
The aim of our study was to investigate contemporary trends in the adoption of MINU in the United States compared with open nephroureterectomy (ONU).
Patients who underwent ONU or MINU between 2011 and 2021 were retrospectively analyzed using PearlDiver Mariner, an all-payer insurance claims database. International Classification of Diseases diagnosis and procedure codes were used to identify the type of surgical procedure, patients' characteristics, social determinants of health (SDOH), and perioperative complications. The primary objective assessed different trends and costs in NU adoption, while secondary objectives analyzed factors influencing the postoperative complications, including SDOH. Outcomes were compared using multivariable regression models.
Overall, 15,240 patients underwent ONU (n = 7675) and MINU (n = 7565). Utilization of ONU declined over the study period, whereas that of MINU increased from 29 to 72% (p = 0.01). The 60-day postoperative complication rate was 23% for ONU and 19% for MINU (p < 0.001). At multivariable analysis, ONU showed a significantly higher risk of postoperative complications (odds ratio 1.33, 95% CI 1.20-1.48). Approximately 5% and 9% of patients reported at least one SDOH at baseline for both ONU and MINU (p < 0.001).
Contemporary trend analysis of a large national dataset confirms that there has been a significant shift towards MINU, which is gradually replacing ONU. A minimally invasive approach is associated with lower risk of complications. SDOH are non-clinical factors that currently do not have an impact on the outcomes of nephroureterectomy.
微创肾输尿管切除术（MINU），特别是机器人辅助腹腔镜手术，在许多机构中的应用越来越广泛，这是普遍公认的。
我们的研究旨在调查与开放肾输尿管切除术（ONU）相比，MINU 在美国的应用的当代趋势。
使用 PearlDiverMariner（一种全支付者保险索赔数据库）对 2011 年至 2021 年间接受 ONU 或 MINU 的患者进行回顾性分析。国际疾病分类诊断和手术代码用于识别手术类型、患者特征、社会决定因素（SDOH）和围手术期并发症。主要目的评估了 NU 采用的不同趋势和成本，次要目的分析了影响术后并发症的因素，包括 SDOH。使用多变量回归模型比较结果。
总体而言，有 15240 名患者接受了 ONU（n=7675）和 MINU（n=7565）治疗。研究期间，ONU 的使用率下降，而 MINU 的使用率从 29%上升到 72%（p=0.01）。ONU 的 60 天术后并发症发生率为 23%，MINU 为 19%（p<0.001）。在多变量分析中，ONU 显示术后并发症的风险显著更高（比值比 1.33，95%置信区间 1.20-1.48）。大约 5%和 9%的接受 ONU 和 MINU 治疗的患者在基线时有至少一个 SDOH（p<0.001）。
对大型国家数据集的当代趋势分析证实，MINU 的应用已显著转移，逐渐取代了 ONU。微创方法与较低的并发症风险相关。SDOH 是非临床因素，目前对肾输尿管切除术的结果没有影响。
