TY - JOUR
T1 - Variation in use of nephron-sparing surgery among children with renal tumors
AU - Chu, David I.
AU - Lloyd, Jessica C.
AU - Balsara, Zarine R.
AU - Wiener, John S.
AU - Ross, Sherry S.
AU - Routh, Jonathan C.
N1 - Funding Information:
Dr. Routh is supported by grant number K12-DK100024 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Publisher Copyright:
© 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
PY - 2014/8/1
Y1 - 2014/8/1
N2 - Objective Given the negative long-term effects of renal insufficiency, nephron-sparing surgery (NSS) is increasingly discussed for the treatment of pediatric renal tumors. We sought to examine variation in practice patterns of NSS among children with renal tumors.Materials and methods We performed a retrospective cohort analysis of claims data for pediatric inpatient admissions captured by the Kids Inpatient Database (1997-2009). We identified children with renal tumors who underwent surgery, including radical nephrectomy (RN) and NSS. We used multivariable logistic regression to assess the relationship between use of NSS and various clinical, demographic, and geographic predictors of interest.Results We identified 10,108 pediatric inpatient admissions for renal tumors. Of these, 1657 were surgical admissions, with 1501 patients (90.5%) undergoing RN and 156 (9.5%) undergoing NSS. On multivariable analysis, NSS was associated only with a concomitant diagnosis of renal insufficiency (relative ratio [RR] 3.37, p = 0.01) and surgery in the Northeastern USA (RR 3.07, p = 0.03). Race/ethnicity, age, payer type, procedure year, and other non-clinical factors were not significantly associated with NSS.Conclusion In a large, nationwide pediatric cohort, RN remains the most common surgical intervention for renal tumors. NSS is significantly associated with a diagnosis of renal insufficiency, but not non-clinical factors such as patient gender or race.
AB - Objective Given the negative long-term effects of renal insufficiency, nephron-sparing surgery (NSS) is increasingly discussed for the treatment of pediatric renal tumors. We sought to examine variation in practice patterns of NSS among children with renal tumors.Materials and methods We performed a retrospective cohort analysis of claims data for pediatric inpatient admissions captured by the Kids Inpatient Database (1997-2009). We identified children with renal tumors who underwent surgery, including radical nephrectomy (RN) and NSS. We used multivariable logistic regression to assess the relationship between use of NSS and various clinical, demographic, and geographic predictors of interest.Results We identified 10,108 pediatric inpatient admissions for renal tumors. Of these, 1657 were surgical admissions, with 1501 patients (90.5%) undergoing RN and 156 (9.5%) undergoing NSS. On multivariable analysis, NSS was associated only with a concomitant diagnosis of renal insufficiency (relative ratio [RR] 3.37, p = 0.01) and surgery in the Northeastern USA (RR 3.07, p = 0.03). Race/ethnicity, age, payer type, procedure year, and other non-clinical factors were not significantly associated with NSS.Conclusion In a large, nationwide pediatric cohort, RN remains the most common surgical intervention for renal tumors. NSS is significantly associated with a diagnosis of renal insufficiency, but not non-clinical factors such as patient gender or race.
KW - Kidney neoplasms
KW - Nephrectomy
KW - Pediatrics
KW - Practice pattern variations
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U2 - 10.1016/j.jpurol.2013.12.019
DO - 10.1016/j.jpurol.2013.12.019
M3 - Article
C2 - 24517904
AN - SCOPUS:84908330459
SN - 1477-5131
VL - 10
SP - 724
EP - 729
JO - Journal of Pediatric Urology
JF - Journal of Pediatric Urology
IS - 4
ER -