Franco Antonio, Lombardo Riccardo, Ditonno Francesco, Bologna Eugenio, Licari Leslie Claire, Nabulsi Omar, Ioos Darren, Gallo Giacomo, Tema Giorgia, Cicione Antonio, Nacchia Antonio, Tubaro Andrea, De Nunzio Cosimo, Cherullo Edward E, Autorino Riccardo
Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA.
Department of Urology, Sant'Andrea Hospital, La Sapienza University, 00185 Rome, Italy.
J Clin Med. 2024 Sep 14;13(18):5454. doi: 10.3390/jcm13185454.
To investigate temporal trends and overall complication rates among open partial nephrectomy (OPN) and minimally invasive partial nephrectomy (MIPN), including the impact of social determinants of health (SDOH) on postoperative outcomes. Patients who underwent OPN or MIPN between 2011 and 2021 were retrospectively analyzed by using PearlDiver-Mariner, an all-payer insurance claims database. The International Classification of Diseases diagnosis and procedure codes were used to identify the type of surgical operation, patient's characteristics (age, sex, region, insurance plan), postoperative complications and SDOH, categorized in education, healthcare, environmental, social, and economic domains. Outcomes were compared using multivariable regression models. Overall, 65,325 patients underwent OPN (n = 23,377) or MIPN (n = 41,948). OPN adoption declined over the study period, whereas that of MIPN increased from 24% to 34% ( = 0.001). The 60-day postoperative complication rate was 15% for the open and 9% for the minimally invasive approach. Approximately 16% and 11% of patients reported at least one SDOH at baseline for OPN and MIPN, respectively. SDOH were associated with higher odds of postoperative complications (OPN = OR: 1.11, 95% CI: 1.01-1.25; MIPN = OR: 1.31, 95% CI: 1.18-1.46). The open approach showed a significantly higher risk of postoperative complications (OR: 1.62, 95% CI: 1.54-1.70) compared to the minimally invasive one. Our findings confirm that MIPN is gradually replacing OPN, which carries a higher risk of complications. SDOH are significant predictors of postoperative complications following PN, regardless of the approach.
为研究开放性部分肾切除术（OPN）和微创性部分肾切除术（MIPN）的时间趋势及总体并发症发生率，包括健康的社会决定因素（SDOH）对术后结局的影响。利用全付费保险理赔数据库PearlDiver-Mariner对2011年至2021年间接受OPN或MIPN的患者进行回顾性分析。使用国际疾病分类诊断和手术编码来确定手术类型、患者特征（年龄、性别、地区、保险计划）、术后并发症和SDOH，并按教育、医疗保健、环境、社会和经济领域进行分类。使用多变量回归模型比较结局。总体而言，65325例患者接受了OPN（n = 23377）或MIPN（n = 41948）。在研究期间，OPN的采用率下降，而MIPN的采用率从24%增至34%（P = 0.001）。开放性手术的术后60天并发症发生率为15%，微创性手术为9%。分别约有16%和11%的OPN和MIPN患者在基线时报告至少一项SDOH。SDOH与术后并发症的较高几率相关（OPN = 比值比：1.11，95%置信区间：1.01 - 1.25；MIPN = 比值比：1.31，95%置信区间：1.18 - 1.46）。与微创方法相比，开放性手术显示出显著更高的术后并发症风险（比值比：1.62，95%置信区间：1.54 - 1.70）。我们的研究结果证实，MIPN正在逐渐取代OPN，而OPN具有更高的并发症风险。无论采用何种方法，SDOH都是PN术后并发症的重要预测因素。
