Contemporary Use of Partial Nephrectomy: Are Older Patients With Impaired Kidney Function Being Left Behind?
Contemporary Use of Partial Nephrectomy: Are Older Patients With Impaired Kidney Function Being Left Behind?
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DOI：
10.1016/j.urology.2016.08.044
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发表时间：
2017-02-01
期刊：
影响因子：
2.1
通讯作者：
Brooks, James D.
中科院分区：
文献类型：
--
作者：
Leppert, John T.;Mittakanti, Harsha R.;Brooks, James D.
目的评估患者因素，如年龄和术前肾功能，是否与接受肾部分切除术在一个国家综合healthcare system.MATERIALS和方法，我们确定了从2002年到2014年在退伍军人健康管理局根治性或肾部分切除术治疗的患者。我们研究了患者年龄、性别、种族或民族、多发病、基线肾功能、肿瘤特征和接受肾部分切除术之间的关系。我们估计了接受肾部分切除术的几率，并评估了协变量和手术年份之间的相互作用，以探索与肾部分切除术相关的患者因素是否随着时间的推移而变化。结果在我们的14，186名患者队列中，4508名（31.2%）接受了肾部分切除术。肾部分切除术的使用从2002年的17%增加到2008年的32%和2014年的38%。患者种族、年龄、肿瘤分期和手术年份与接受肾部分切除术独立相关。黑人退伍军人接受肾部分切除术的几率显著增加，而老年患者的几率显著降低。肾部分切除术的利用率随着时间的推移增加，但年龄较大的患者和基线肾功能较差的患者表现出增加的几率最小的肾部分切除术。结论：虽然肾部分切除术的利用率增加，所有组，最大的增加发生在最年轻的患者和那些最高的基线肾功能。这些趋势需要进一步研究，以确保尽可能考虑肾功能受损风险最高的患者进行肾部分切除术。爱思唯尔公司出版
OBJECTIVE To assess whether patient factors, such as age and preoperative kidney function, were associated with receipt of partial nephrectomy in a national integrated healthcare system.MATERIALS AND METHODS We identified patients treated with a radical or partial nephrectomy from 2002 to 2014 in the Veterans Health Administration. We examined associations among patient age, sex, race or ethnicity, multimorbidity, baseline kidney function, tumor characteristics, and receipt of partial nephrectomy. We estimated the odds of receiving a partial nephrectomy and assessed interactions between covariates and the year of surgery to explore whether patient factors associated with partial nephrectomy changed over time.RESULTS In our cohort of 14,186 patients, 4508 (31.2%) received a partial nephrectomy. Use of partial nephrectomy increased from 17% in 2002 to 32% in 2008 and to 38% in 2014. Patient race or ethnicity, age, tumor stage, and year of surgery were independently associated with receipt of partial nephrectomy. Black veterans had significantly increased odds of receipt of partial nephrectomy, whereas older patients had significantly reduced odds. Partial nephrectomy utilization increased for all groups over time, but older patients and patients with worse baseline kidney function showed the least increase in odds of partial nephrectomy.CONCLUSION Although the utilization of partial nephrectomy increased for all groups, the greatest increase occurred in the youngest patients and those with the highest baseline kidney function. These trends warrant further investigation to ensure that patients at the highest risk of impaired kidney function are considered for partial nephrectomy whenever possible. Published by Elsevier Inc.