Trends in Partial and Radical Nephrectomy: An Analysis of Case Logs from Certifying Urologists

Abstract

Purpose Surgical treatment options for renal masses include radical versus partial nephrectomy and the open versus laparoscopic approach. Using American Board of Urology case log data, we investigated contemporary trends in these treatment options and how surgeon and practice characteristics may influence these trends. Materials and Methods Annualized case log data for nephrectomies were obtained from the American Board of Urology for all urologists certifying or recertifying, from 2002 to 2010. We evaluated the trends in nephrectomy use. Logistic regressions were used to evaluate surgeon and practice characteristics as predictors for partial and laparoscopic procedures. Results From the 3,852 case logs submitted by non-pediatric urologists, 48,384 nephrectomies were analyzed. From 2002 to 2010, the proportion of annual nephrectomies that were performed as open radical nephrectomies gradually decreased from 54% to 29%. During the same period, there was a moderate gradual increase of laparoscopic radical nephrectomy usage, from 30% to 39%. The proportion of open partial nephrectomy remained stable at 15% while laparoscopic partial nephrectomy increased from 2% to 17%. On multivariable analysis, usage of partial nephrectomy and laparoscopy was predicted by a urologist’s annual nephrectomy volume, initial or recertification status, subspecialty, practice area size, and geographic region. Conclusions Since 2002, usage of laparoscopic nephrectomy and partial nephrectomy has increased. However, the diffusion of these techniques is not uniform. Initial certification, higher surgical volume, and practicing in areas over 1,000,000 and northeast region were associated with higher usage of laparoscopy and partial nephrectomy. Factors that affect the adoption of these techniques require further research.

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