Trends in Utilization of Robotic and Open Partial Nephrectomy for Management of cT1 Renal Masses

Mahmoud Alameddine, Tulay Sengul, Kevin J. Moore, Feng Miao, Luís Felipe Sávio, Bruno Nahar, Nachiketh Soodana Prakash, Vivek Venkatramani, Joshua S. Jue, Sanoj Punnen, Dipen J Parekh, Chad Ritch, Mark L Gonzalgo

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Partial nephrectomy is widely used for surgical management of small renal masses. Use of robotic (RPN) versus open partial nephrectomy (OPN) among various populations is not well characterized. Objective: To analyze trends in utilization of RPN and disparities that may be associated with this procedure for management of cT1 renal masses in the USA. Design, setting, and participants: Patients who underwent RPN or OPN for clinical stage T1N0M0 renal masses in the USA from 2010 to 2013 were identified in the National Cancer Data Base. A total of 23 154 patients fulfilled the inclusion criteria. Outcome measurements and statistical analysis: Univariable and multivariable logistic regression analyses were performed to evaluate differences in receiving RPN or OPN across various patient groups. Results and limitations: Utilization of RPN increased from 41% in 2010 to 63% in 2013. Black patients (adjusted odds ratio [aOR] 0.91, 95% confidence interval [CI] 0.84-0.98) and Hispanic patients (aOR 0.85, 95% CI 0.77-0.95) were less likely to undergo RPN. RPN was less likely to be performed in rural counties (aOR 0.80, 95% CI 0.66-0.98) and in patients with no insurance (aOR 0.52, 95% CI 0.44-0.61) or patients covered by Medicaid (aOR 0.81, 95% CI 0.73-0.90). There was no significant difference in RPN utilization between academic and non-academic facilities. Patients with higher clinical stage (aOR 0.58, 95% CI 0.55-0.62) and comorbidities (aOR 0.79, 95% CI 0.71-0.88) were also less likely to undergo RPN. Conclusions: Utilization of RPN has continued to increase over time; however, there are significant disparities in its utilization according to race and socioeconomic status. Black and Hispanic patients and patients in rural communities and with limited insurance were more likely to be treated with OPN instead of RPN. Patient summary: The use of robotic surgery in partial nephrectomy for management of small renal masses has increased over time. We found a significant disparity across different racial and socioeconomic groups in use of robotic partial nephrectomy compared to open surgery. Patients living in rural areas, with limited insurance, and multiple medical comorbidities were more likely to undergo open than robotic partial nephrectomy. Despite the increased use of robotic partial nephrectomy for management of cT1 renal masses, there is significant disparity in its utilization across different racial and sociodemographic groups in the USA.

Original languageEnglish (US)
JournalEuropean Urology Focus
DOIs
StateAccepted/In press - Jan 1 2018

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Robotics
Nephrectomy
Kidney
Odds Ratio
Confidence Intervals
Insurance
Hispanic Americans
Comorbidity
Medicaid
Rural Population
Social Class
Logistic Models
Regression Analysis
Databases

Keywords

  • Healthcare disparities
  • Kidney neoplasm
  • Nephrectomy
  • Robotic surgical procedure
  • Trends

ASJC Scopus subject areas

  • Urology

Cite this

Trends in Utilization of Robotic and Open Partial Nephrectomy for Management of cT1 Renal Masses. / Alameddine, Mahmoud; Sengul, Tulay; Moore, Kevin J.; Miao, Feng; Sávio, Luís Felipe; Nahar, Bruno; Prakash, Nachiketh Soodana; Venkatramani, Vivek; Jue, Joshua S.; Punnen, Sanoj; Parekh, Dipen J; Ritch, Chad; Gonzalgo, Mark L.

In: European Urology Focus, 01.01.2018.

Research output: Contribution to journalArticle

Alameddine, Mahmoud ; Sengul, Tulay ; Moore, Kevin J. ; Miao, Feng ; Sávio, Luís Felipe ; Nahar, Bruno ; Prakash, Nachiketh Soodana ; Venkatramani, Vivek ; Jue, Joshua S. ; Punnen, Sanoj ; Parekh, Dipen J ; Ritch, Chad ; Gonzalgo, Mark L. / Trends in Utilization of Robotic and Open Partial Nephrectomy for Management of cT1 Renal Masses. In: European Urology Focus. 2018.
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title = "Trends in Utilization of Robotic and Open Partial Nephrectomy for Management of cT1 Renal Masses",
abstract = "Background: Partial nephrectomy is widely used for surgical management of small renal masses. Use of robotic (RPN) versus open partial nephrectomy (OPN) among various populations is not well characterized. Objective: To analyze trends in utilization of RPN and disparities that may be associated with this procedure for management of cT1 renal masses in the USA. Design, setting, and participants: Patients who underwent RPN or OPN for clinical stage T1N0M0 renal masses in the USA from 2010 to 2013 were identified in the National Cancer Data Base. A total of 23 154 patients fulfilled the inclusion criteria. Outcome measurements and statistical analysis: Univariable and multivariable logistic regression analyses were performed to evaluate differences in receiving RPN or OPN across various patient groups. Results and limitations: Utilization of RPN increased from 41{\%} in 2010 to 63{\%} in 2013. Black patients (adjusted odds ratio [aOR] 0.91, 95{\%} confidence interval [CI] 0.84-0.98) and Hispanic patients (aOR 0.85, 95{\%} CI 0.77-0.95) were less likely to undergo RPN. RPN was less likely to be performed in rural counties (aOR 0.80, 95{\%} CI 0.66-0.98) and in patients with no insurance (aOR 0.52, 95{\%} CI 0.44-0.61) or patients covered by Medicaid (aOR 0.81, 95{\%} CI 0.73-0.90). There was no significant difference in RPN utilization between academic and non-academic facilities. Patients with higher clinical stage (aOR 0.58, 95{\%} CI 0.55-0.62) and comorbidities (aOR 0.79, 95{\%} CI 0.71-0.88) were also less likely to undergo RPN. Conclusions: Utilization of RPN has continued to increase over time; however, there are significant disparities in its utilization according to race and socioeconomic status. Black and Hispanic patients and patients in rural communities and with limited insurance were more likely to be treated with OPN instead of RPN. Patient summary: The use of robotic surgery in partial nephrectomy for management of small renal masses has increased over time. We found a significant disparity across different racial and socioeconomic groups in use of robotic partial nephrectomy compared to open surgery. Patients living in rural areas, with limited insurance, and multiple medical comorbidities were more likely to undergo open than robotic partial nephrectomy. Despite the increased use of robotic partial nephrectomy for management of cT1 renal masses, there is significant disparity in its utilization across different racial and sociodemographic groups in the USA.",
keywords = "Healthcare disparities, Kidney neoplasm, Nephrectomy, Robotic surgical procedure, Trends",
author = "Mahmoud Alameddine and Tulay Sengul and Moore, {Kevin J.} and Feng Miao and S{\'a}vio, {Lu{\'i}s Felipe} and Bruno Nahar and Prakash, {Nachiketh Soodana} and Vivek Venkatramani and Jue, {Joshua S.} and Sanoj Punnen and Parekh, {Dipen J} and Chad Ritch and Gonzalgo, {Mark L}",
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TY - JOUR

T1 - Trends in Utilization of Robotic and Open Partial Nephrectomy for Management of cT1 Renal Masses

AU - Alameddine, Mahmoud

AU - Sengul, Tulay

AU - Moore, Kevin J.

AU - Miao, Feng

AU - Sávio, Luís Felipe

AU - Nahar, Bruno

AU - Prakash, Nachiketh Soodana

AU - Venkatramani, Vivek

AU - Jue, Joshua S.

AU - Punnen, Sanoj

AU - Parekh, Dipen J

AU - Ritch, Chad

AU - Gonzalgo, Mark L

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Partial nephrectomy is widely used for surgical management of small renal masses. Use of robotic (RPN) versus open partial nephrectomy (OPN) among various populations is not well characterized. Objective: To analyze trends in utilization of RPN and disparities that may be associated with this procedure for management of cT1 renal masses in the USA. Design, setting, and participants: Patients who underwent RPN or OPN for clinical stage T1N0M0 renal masses in the USA from 2010 to 2013 were identified in the National Cancer Data Base. A total of 23 154 patients fulfilled the inclusion criteria. Outcome measurements and statistical analysis: Univariable and multivariable logistic regression analyses were performed to evaluate differences in receiving RPN or OPN across various patient groups. Results and limitations: Utilization of RPN increased from 41% in 2010 to 63% in 2013. Black patients (adjusted odds ratio [aOR] 0.91, 95% confidence interval [CI] 0.84-0.98) and Hispanic patients (aOR 0.85, 95% CI 0.77-0.95) were less likely to undergo RPN. RPN was less likely to be performed in rural counties (aOR 0.80, 95% CI 0.66-0.98) and in patients with no insurance (aOR 0.52, 95% CI 0.44-0.61) or patients covered by Medicaid (aOR 0.81, 95% CI 0.73-0.90). There was no significant difference in RPN utilization between academic and non-academic facilities. Patients with higher clinical stage (aOR 0.58, 95% CI 0.55-0.62) and comorbidities (aOR 0.79, 95% CI 0.71-0.88) were also less likely to undergo RPN. Conclusions: Utilization of RPN has continued to increase over time; however, there are significant disparities in its utilization according to race and socioeconomic status. Black and Hispanic patients and patients in rural communities and with limited insurance were more likely to be treated with OPN instead of RPN. Patient summary: The use of robotic surgery in partial nephrectomy for management of small renal masses has increased over time. We found a significant disparity across different racial and socioeconomic groups in use of robotic partial nephrectomy compared to open surgery. Patients living in rural areas, with limited insurance, and multiple medical comorbidities were more likely to undergo open than robotic partial nephrectomy. Despite the increased use of robotic partial nephrectomy for management of cT1 renal masses, there is significant disparity in its utilization across different racial and sociodemographic groups in the USA.

AB - Background: Partial nephrectomy is widely used for surgical management of small renal masses. Use of robotic (RPN) versus open partial nephrectomy (OPN) among various populations is not well characterized. Objective: To analyze trends in utilization of RPN and disparities that may be associated with this procedure for management of cT1 renal masses in the USA. Design, setting, and participants: Patients who underwent RPN or OPN for clinical stage T1N0M0 renal masses in the USA from 2010 to 2013 were identified in the National Cancer Data Base. A total of 23 154 patients fulfilled the inclusion criteria. Outcome measurements and statistical analysis: Univariable and multivariable logistic regression analyses were performed to evaluate differences in receiving RPN or OPN across various patient groups. Results and limitations: Utilization of RPN increased from 41% in 2010 to 63% in 2013. Black patients (adjusted odds ratio [aOR] 0.91, 95% confidence interval [CI] 0.84-0.98) and Hispanic patients (aOR 0.85, 95% CI 0.77-0.95) were less likely to undergo RPN. RPN was less likely to be performed in rural counties (aOR 0.80, 95% CI 0.66-0.98) and in patients with no insurance (aOR 0.52, 95% CI 0.44-0.61) or patients covered by Medicaid (aOR 0.81, 95% CI 0.73-0.90). There was no significant difference in RPN utilization between academic and non-academic facilities. Patients with higher clinical stage (aOR 0.58, 95% CI 0.55-0.62) and comorbidities (aOR 0.79, 95% CI 0.71-0.88) were also less likely to undergo RPN. Conclusions: Utilization of RPN has continued to increase over time; however, there are significant disparities in its utilization according to race and socioeconomic status. Black and Hispanic patients and patients in rural communities and with limited insurance were more likely to be treated with OPN instead of RPN. Patient summary: The use of robotic surgery in partial nephrectomy for management of small renal masses has increased over time. We found a significant disparity across different racial and socioeconomic groups in use of robotic partial nephrectomy compared to open surgery. Patients living in rural areas, with limited insurance, and multiple medical comorbidities were more likely to undergo open than robotic partial nephrectomy. Despite the increased use of robotic partial nephrectomy for management of cT1 renal masses, there is significant disparity in its utilization across different racial and sociodemographic groups in the USA.

KW - Healthcare disparities

KW - Kidney neoplasm

KW - Nephrectomy

KW - Robotic surgical procedure

KW - Trends

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