Association of type of renal surgery and access to robotic technology for kidney cancer: results from a population-based cohort.

Objective To evaluate the relationship between partial nephrectomy ( PN) and hospital availability of robot-assisted surgery from a population-based cohort in the USA. Methods After merging the Nationwide Inpatient Sample ( NIS) and the American Hospital Association survey from 2006 to 2008, we identified 21 179 patients who underwent either PN or radical nephrectomy ( RN) for renal cell carcinoma ( RCC). The primary outcome assessed was the type of nephrectomy performed. Multivariable logistic regression identified the patient and hospital characteristics associated with receipt of PN. Results We identified 4832 (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 centres (odds ratio [ OR] 2.77; P < 0.001), urban centres ( OR 3.66; P < 0.001) and American College of Surgeons ( ACOS)-designated cancer centres ( OR: 1.10; P < 0.05) compared with non-academic, rural and non- ACOS-designated cancer centre hospitals, respectively. Robot-assisted surgery availability at a hospital was also associated with a higher adjusted odds of PN compared with centres without that availability ( OR 1.28; P < 0.001). Conclusions Although academic and urban locations are establi shed factors that affect the receipt of PN for RCC, the availability of robot-assisted 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. [ABSTRACT FROM AUTHOR]