A population based study of surgeon characteristics associated with the uptake of contemporary techniques in renal surgery

Abstract

Introduction: We have witnessed the slow uptake of many contemporary techniques in the surgical management of renal tumours. We sought to evaluate surgeon-level characteristics associated with the uptake of laparoscopy, partial nephrectomy (PN) and adrenalsparing approaches in surgically managing these tumours. Methods: Using the Ontario Cancer Registry, we identified surgeons treating renal cell carcinoma (RCC) in the province of Ontario, Canada between 2002 and 2004. We then classified individuals within this cohort as either high or low utilizers of laparoscopy, PN or adrenal-sparing approaches. Further variables analyzed included academic status, surgeon graduation year and surgical volume status. We then used univariable and multivariable logistic regression models to assess predictors of uptake. Results: We evaluated a total of 108 surgeons for their uptake of both laparoscopy and adrenal-sparing approaches and 94 surgeons for their uptake of PN. We identified 32 surgeons (30%) as high users of laparoscopy. Predictors of uptake of laparoscopy included graduation year after 1990 (odds ratio [OR] 4.81, confidence interval [CI] 1.57-14.8) and high-surgeon volume (OR 4.33, CI 1.60-10.4). We identified 41 surgeons (44%) as high users of PN. The only predictor of uptake of PN was academic status (OR 5.83,. We identified 69 surgeons (65%) as high users of adrenal-sparing approaches, but did not identify any significant predictors for uptake in this group. Discussion: We identify unique factors contributing to the uptake of distinct surgical techniques in the management of RCC. This information sheds lights on the underlying mechanisms and helps us understand how to further encourage the dissemination of these practices.

Predictors of surgical approach for the management of renal cell carcinoma: a population‐based study from New South Wales

“…Increasing adoption of laparoscopy with time is an expected finding but again treatment in a private hospital is explained potentially by early consultant adoption of the new technique compared to registrars and the need for new laparoscopic equipment, which is quicker to obtain in private compared with public hospitals. Higher hospital volume and uptake of laparoscopic nephrectomy have been reported previously and are also associated with surgeon volume . This finding may again have implications with regards to the delivery of services.…”

“…Higher hospital volume and uptake of laparoscopic nephrectomy have been reported previously 20 and are also associated with surgeon volume. 21 This finding may again have implications with regards to the delivery of services.…”

Practice patterns for the surgical treatment of T1 renal cell carcinoma: A nationwide population-based register study

“…However, there were also significant differences in the number of NSS in T1a tumours between the university hospitals, ranging from 31% to 88%. This difference may indicate a lack of current knowledge of recommendations or surgical skills by the physicians, or may in part be due to the use of laparoscopic nephrectomy having a negative impact on the use of NSS, as suggested in previous studies [13,20,22]. Another striking observation in this study is the observed difference in treatment offered for T1 RCC in the 21 independent healthcare counties.…”

Postoperative 30-day Mortality Rates for Kidney Cancer Are Dependent on Hospital Surgical Volume: Results from a Norwegian Population-based Study

“…PN was more frequent among younger surgeons in university hospitals, increasing renal case volume and the percentage of PN [18,272]. Predictors of doing MIM were also younger surgeons and high surgeon volumes [273]. The characterization of surgeon level on the uptake of contemporary treatment is not well understood, and many factors are probably involved.…”