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Contemporary Use of Partial Nephrectomy: Are Older Patients With Impaired Kidney Function Being Left Behind?
- Source :
- Urology. 100
- Publication Year :
- 2016
-
Abstract
- 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.
- Subjects :
- Adult
Male
medicine.medical_specialty
Urology
medicine.medical_treatment
030232 urology & nephrology
Renal function
Nephrectomy
Article
Odds
03 medical and health sciences
0302 clinical medicine
Older patients
Patient age
medicine
Humans
Renal Insufficiency
Carcinoma, Renal Cell
Patient factors
Aged
Neoplasm Staging
Retrospective Studies
Veterans
business.industry
Patient Selection
Age Factors
Middle Aged
Left behind
Kidney Neoplasms
Surgery
Logistic Models
Socioeconomic Factors
030220 oncology & carcinogenesis
Creatinine
Cohort
Female
business
Subjects
Details
- ISSN :
- 15279995
- Volume :
- 100
- Database :
- OpenAIRE
- Journal :
- Urology
- Accession number :
- edsair.doi.dedup.....9b634b168b8afbf513dc1f1611d9fefb