Trends in Renal Surgery: Robotic Technology is Associated with Increased Use of Partial Nephrectomy
Trends in Renal Surgery: Robotic Technology is Associated with Increased Use of Partial Nephrectomy
复制标题
DOI：
10.1016/j.juro.2012.10.024
复制
发表时间：
2013-04-01
影响因子：
6.6
通讯作者：
Allaf, Mohamad E.
中科院分区：
文献类型：
--
作者：
Patel, Hiten D.;Mullins, Jeffrey K.;Allaf, Mohamad E.
目的：在最近的基于人群的分析中，发现部分肾切除术与根治性肾切除术在治疗肾肿瘤中的应用不足。一个解释是与腹腔镜部分肾切除术相关的学习曲线。我们分析了肾外科的发展趋势及其与机器人技术的引入的关系。材料和方法：我们使用马里兰州HSCRC（卫生服务成本审查委员会）数据库来识别2000年至2011年间接受根治性或部分性肾切除术或肾消融术的患者。使用多元逻辑回归分析使用趋势以及相关的患者和医院因素。ICD-9机器人修改代码于2008年10月建立。结果：在纳入分析的14,260例患者中，分别有11,271例（79.0%）、2,622例（18.4%）和367例（2.6%）接受了肾根治性、部分性切除术和肾消融术。部分肾切除术从2000年的8.6%上升到2011年的27%。开放根治性肾切除术减少33%，微创根治性肾切除术增加15%。从2008年到2011年，机器人辅助腹腔镜部分肾切除术的比例有所增加，在大学医院达到14%，在非大学医院达到10% （p = 0.03）。与部分肾切除术增加相关（OR 9.67, p < 0.001）。在整体分析中，较年轻的年龄、男性和较低的患者复杂性是部分肾切除术的预测因素，而较高的医院数量和大学学历仅在早期是预测因素。结论：2001 - 2011年，机器人技术促进了马里兰州部分肾切除术的应用。与医院因素的相关性随着时间的推移而降低。这些数据表明，机器人技术可以使外科医生在实践中更频繁地进行保留肾元的手术。
Purpose: Underuse of partial vs radical nephrectomy for renal tumors was noted in recent population based analyses. An explanation is the learning curve associated with laparoscopic partial nephrectomy. We analyzed state trends in renal surgery and their relationship to the introduction of robotic technology.Materials and Methods: We used the Maryland HSCRC (Health Services Cost Review Commission) database to identify patients who underwent radical or partial nephrectomy, or renal ablation from 2000 to 2011. Utilization trends, and associated patient and hospital factors were analyzed using multivariate logistic regression. ICD-9 robotic modifier codes were established in October 2008.Results: Of the 14,260 patients included in analysis 11,271 (79.0%), 2,622 (18.4%) and 367 (2.6%) underwent radical and partial nephrectomy, and renal ablation, respectively. Partial nephrectomy increased from 8.6% in 2000 to 27% in 2011. Open radical nephrectomy decreased by 33%, while minimally invasive radical nephrectomy increased by 15%. Robot-assisted laparoscopic partial nephrectomy increased from 2008 to 2011, attaining a 14% rate at university and 10% at nonuniversity hospitals (p = 0.03). It was associated with increased partial nephrectomy (OR 9.67, p < 0.001). Younger age, male gender and low patient complexity predicted partial nephrectomy on overall analysis, while higher hospital volume and university status were predictors only in earlier years.Conclusions: Partial nephrectomy use increased in Maryland from 2001 to 2011, which was facilitated by robotic technology. Associations with hospital factors decreased with time. These data suggest that robotic technology may enable surgeons across practice settings to more frequently perform nephron sparing surgery.