Year: 2018
Type: article
Study design: Observational Study
Abstract: INTRODUCTION AND OBJECTIVES: There has been an increasing trend towards minimally invasive surgery concomitant with tightened restrictions on work hours raising concern over the adequacy of surgical education.The objective of this study was to examine the trends in utilization of open, laparoscopic, and robotic approaches in teaching and nonteaching institutions.METHODS: A retrospective cross sectional analysis was performed using data from the National Inpatient Sample from January 2001 to December 2013.Radical nephrectomy cases were identified by the ICD-9 codes 55.5 for complete nephrectomy and 55.54 for bilateral nephrectomy.Partial nephrectomies were identified by the code 55.4.The ICD-9 code 17.42, available from 2008 onward, was used to identify robotic-assisted laparoscopic cases; 54.21 and 54.51 were used to identify laparoscopic cases.All statistical analyses were performed using STATA, version 12.1.Graphs were constructed using R, version 3.3.2.RESULTS: A total of 106,721 radical nephrectomies were performed during the study period: 87,951 open, 15,105 laparoscopic, and 3,665 robotic.A total of 29,370 partial nephrectomies were performed during the study period: 20,532 open, 2,056 laparoscopic, and 6,782 robotic.Although between 2001 and 2013 there was a decrease in the total number of open radical nephrectomies performed (6098 to 5710), there was an increase in the proportion of open cases being performed at teaching hospitals (3400 cases 55.8% to 3977 cases 69.6%).The number of open partial nephrectomies actually increased from 793 to 1515 overall, and at urban teaching hospitals cases increased from 449 (62.9%) to 1100 (72.6%).Of the 3,665 robotic radical nephrectomies performed 2,543 (69.3%) were at urban teaching hospitals, 1,007 (27.5%) were at urban non-teaching hospitals, and 115 (3.1%) were at rural hospitals.Of the 6,782 robotic partial nephrectomies performed 5014 (73.9%) were at urban teaching hospitals, 1643 (24.2%) were at urban non-teaching hospitals, and 125 (1.8%) were at rural hospitals.CONCLUSIONS: While minimally invasive approaches have been increasing and are preferentially performed at teaching institutions, open renal surgery still represents a large proportion of the cases being performed.
Source: The Journal of Urology
Authors: Neal A. Patel, Christopher Gaffney, Adrien Bernstein, Tianyi Sun, Art Sedrakyan, Jim C. Hu
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2796325454