A comparison of hospital-based charges following partial and radical nephrectomy

McKiernan, James M.; Teschendorf, Bonnie; Katz, Jared; Herr, Harry W.; Russo, Paul

doi:10.1016/s1078-1439(01)00135-1

Cited by 14 publications

(4 citation statements)

References 11 publications

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“…22 Hospital costs and length of stay are similar for partial and radical nephrectomy. 23, 24 Partial nephrectomy reduces the risk of chronic kidney disease and complications thereof including hip fractures and cardiovascular morbidity and mortality. Our results suggest that partial nephrectomy does not compromise overall or cancer-specific mortality compared with radical nephrectomy for tumors up to 7cm.…”

Section: Discussionmentioning

confidence: 99%

Partial Versus Radical Nephrectomy for 4 to 7 cm Renal Cortical Tumors

et al. 2009

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Purpose Recent observations suggest that partial nephrectomy for small renal tumors may be associated with improved survival compared with radical nephrectomy. We evaluated survival in patients with renal tumors 4-7cm using a bi-institutional collaboration. Methods Combining institutional databases from Mayo Clinic and Memorial Sloan-Kettering, we identified 1,159 patients with sporadic, unilateral, solitary and localized renal masses 4.1–7.0 cm who underwent radical or partial nephrectomy between 1989 and 2006. Patient outcome was compared using Cox proportional hazards regression models. Results Among the 1,159 patients, 873 (75%) and 286 (25%) were treated with radical and partial nephrectomy, respectively. Patients treated with partial (vs radical) nephrectomy were significantly more likely to have a solitary kidney (10% vs 0.2%, p<0.001) and chronic kidney disease (15% vs 7%, p<0.001). Median duration of follow-up for survivors was 4.8 years (range 0-19). There was not a significant difference in overall survival when comparing patients treated with radical and partial nephrectomy (p=0.8). Interestingly, in a subset of 943 patients with RCC, those treated with radical nephrectomy were significantly more likely to die from RCC compared with those treated with partial nephrectomy (hazard ratio 2.16; 95% CI 1.04–4.50; p=0.039) although this association only approached statistical significance in a multivariable analysis (hazard ratio 1.97; 95% CI 0.92–4.20; p=0.079). Conclusions Our results suggest that overall and cancer-specific survival is not compromised when partial nephrectomy is utilized for patients with 4-7cm renal cortical tumors. With the benefit of preserving renal function, our results support the use of partial nephrectomy whenever technically feasible for renal tumors up to 7cm.

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Section: Discussionmentioning

confidence: 99%

Partial Versus Radical Nephrectomy for 4 to 7 cm Renal Cortical Tumors

et al. 2009

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“…In elective situations, health related quality of life is improved with partial compared with radical nephrectomy 18. Hospital costs and length of stay are similar for partial and radical nephrectomy 19, 20. Additionally, laparoscopic partial nephrectomy has now been investigated with excellent mid-term oncologic and functional outcomes 21.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Use of Partial Nephrectomy at a Tertiary Care Center in the United States

et al. 2009

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Purpose-Use of partial nephrectomy for renal cortical tumors appears unacceptably low in the United States according to population-based data. We examined the use of partial nephrectomy at our tertiary care facility in the contemporary era.Methods-Using our prospectively maintained nephrectomy database, we identified 1,533 patients treated for a sporadic and localized renal cortical tumor between 2000 and 2007. Patients with bilateral disease or solitary kidneys were excluded and an elective operation required an estimated GFR ≥45 ml/min/1.73m 2 . Predictors of partial nephrectomy were evaluated using logistic regression models.Results-Overall, 854 (56%) and 679 (44%) patients were treated with partial and radical nephrectomy, respectively. Among the 820 patients treated electively for a tumor ≤4cm, the frequency of partial nephrectomy use steadily increased from 69% in the year 2000 to 89% in 2007. Among the 365 patients treated electively for a tumor 4-7cm, the frequency of partial nephrectomy use also steadily increased from 20% in the year 2000 to 60% in 2007. In a multivariate analysis, male gender (p=0.021), later year of surgery (p<0.001), younger age (p=0.004), smaller tumor size (p<0.001), and open surgery (p<0.001) were significant predictors of receiving a partial nephrectomy. ASA score, race, and body mass index were not significantly associated with type of treatment.Conclusions-Use of partial nephrectomy is increasing and is now utilized for ~90% of patients with T1a tumors at our institution. For reasons that remain unclear, certain groups of patients are less likely to be treated with partial nephrectomy.

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“…No difference in length of stay and hospital cost in any individual year examined was found. McKiernan et al[27] compared overall hospital costs in a retrospective review of 103 consecutive cases of renal tumours <4 cm treated by either RN or PN between 1996 and 1999. PN was performed in 66 patients and RN in 37 patients.…”

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confidence: 99%