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ASSOCIATION OF TYPE OF RENAL SURGERY AND ACCESS TO ROBOTIC TECHNOLOGY FOR KIDNEY CANCER: RESULTS FROM A POPULATION-BASED COHORT
Steven V. Kardos, MD1, Brian Shuch, MD1, Peter G. Schulam, MD, PhD1, Cary P. Gross, MD1, Nilay D. Shah, MD2, Quoc-Dien Trinh, MD3, Marc C. Smaldone, MD4, Maxine Sun, PhD5, Christopher J. Weight, MD6, Jesse Sammon, DO7, Leona C. Han, MBA2, Simon P. Kim, MD, MPH1.
1Yale University, New Haven, CT, USA, 2Mayo Clinic, Rochester, MN, USA, 3Harvard Medical School, Brigham and Women’s Hospital, MA, USA, 4Fox Chase Medical Center, Temple University Health System, PA, USA, 5University of Montreal Health Center, Montreal, QC, Canada, 6University of Minnesota, Minneapolis, MN, USA, 7Henry Ford Health System, Detroit, MI, USA.

BACKGROUND: While high volume and academic hospitals have been associated with greater use of partial nephrectomy (PN) performed for renal cell carcinoma (RCC), the effect of robotic technology on PN use remains unknown. Therefore, we sought to evaluate the relationship of PN and hospital availability of robotic surgery from a population-based cohort in the U.S.
METHODS: After merging the Nationwide Inpatient Sample (NIS) and the American Hospital Association (AHA) survey from 2006 to 2008, we identified 21,179 patients who underwent either PN or radical nephrectomy (RN) for RCC. The primary outcome was the type of nephrectomy performed. Multivariable logistic regression identified patient and hospital characteristics associated with receipt of PN.
RESULTS: We identified 4,832 (22.8%) and 16,347 (77.2%) patients who were treated for RCC with PN and RN, respectively. On multivariable analysis, patients were more likely to receive PN at academic (OR: 2.77; p<0.001), urban (OR: 3.66; p<0.001), and American College of Surgeon (ACOS) designated cancer centers (OR: 1.10; p<0.05) compared to non-academic, rural, and non-designated cancer center hospitals, respectively. Robotic availability at a hospital was associated with higher adjusted odds of PN compared centers without robotic surgery (OR: 1.28; p<0.001).
CONCLUSIONS: While academic and urban locations are established characteristics influencing receipt of PN for RCC, the presence of robotic surgery at a hospital was also independently associated with higher use of PN. Our results are informative in identifying other key hospital characteristics which may facilitate greater adoption of PN.


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