Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, New York.
Urol Pract. 2024 Nov;11(6):921-929. doi: 10.1097/UPJ.0000000000000673. Epub 2024 Jul 17.
Live donor nephrectomy (LDN) is performed by various specialty surgeons, including urologists, general surgeons, and transplant surgeons. However, national practice patterns and outcomes associated with surgeon specialty have not been previously explored. Here, we investigate surgeon specialty trends, perioperative complications, hospital length of stay, cost, and charge for LDN according to surgeon specialty.
Patients who underwent LDN from 2000 to quarter 1 of 2020 were identified in the Premier Healthcare Database. Associations between physician specialty and 3-month complications, hospital length of stay, institutional cost, and patient charge for LDN procedures were examined using multivariable regression.
We identified 11,418 patients who underwent LDN. Of these cases, 3387 (29.7%) were performed by urologists, 3127 (27.4%) by transplant surgeons, 3928 (34.4%) by general surgeons, and 976 (8.5%) by other specialties. In 2000, urologists performed 35.92% of LDNs, decreasing to 18.91% by 2019 ( < .001 for trend). In the last 5 years, we found no significant difference in complications or length of stay according to surgeon specialty. LDNs performed by a urologist ($57,289, 95% CI $49,292-$66,582) were associated with lower patient charges than those performed by a general surgeon ($68,501, 95% CI $59,090-$79,412) or transplant surgeon ($62,639, 95% CI $53,993-$72,670).
From 2000 to 2019, the proportion of LDNs performed by urologists significantly decreased, while the proportion for transplant surgeons significantly increased, with no significant differences in complications or length of stay across specialties. However, surgeries performed by urologists cost hospitals less and had lower charges for patients.
活体供肾切除术（LDN）由各种专业外科医生进行，包括泌尿科医生、普通外科医生和移植外科医生。然而，国家的实践模式和与外科医生专业相关的结果尚未得到探索。在这里，我们根据外科医生的专业研究外科医生专业趋势、围手术期并发症、住院时间、成本和 LDN 费用。
在 Premier Healthcare Database 中确定了 2000 年至 2020 年第一季度期间接受 LDN 的患者。使用多变量回归检查医生专业与 3 个月并发症、住院时间、机构成本和 LDN 手术患者费用之间的关联。
我们确定了 11418 例接受 LDN 的患者。这些病例中，3387 例（29.7%）由泌尿科医生完成，3127 例（27.4%）由移植外科医生完成，3928 例（34.4%）由普通外科医生完成，976 例（8.5%）由其他专业完成。2000 年，泌尿科医生进行了 35.92%的 LDN，到 2019 年下降到 18.91%（趋势差异<.001）。在过去的 5 年中，我们没有发现根据外科医生的专业LDN 的并发症或住院时间没有差异。泌尿科医生进行的 LDN（57289 美元，95%CI 49292-66582）与普通外科医生（68501 美元，95%CI 59090-79412）或移植外科医生（62639 美元，95%CI 53993-72670）进行的 LDN 相比，患者费用较低。
从 2000 年到 2019 年，泌尿科医生进行的 LDN 比例显著下降，而移植外科医生进行的 LDN 比例显著增加，各专业之间的并发症或住院时间无显著差异。然而，泌尿科医生进行的手术为医院节省了成本，并且患者的费用也较低。
