Authors: Tan HJ, Wolf JS Jr, Ye Z, Hafez KS, Miller DC
Title: Population-level assessment of hospital-based outcomes following laparoscopic versus open partial nephrectomy during the adoption of minimally-invasive surgery.
Journal: J Urol :-
Date: 2013 Nov 07
Abstract: PURPOSE: Because the comparative outcomes of these two procedures remains incompletely defined, we used population-based data to examine resource utilization and short-term outcomes among patients with kidney cancer treated with laparoscopic partial nephrectomy (LPN) versus open partial nephrectomy (OPN). MATERIALS AND METHODS: Using linked SEER-Medicare data, we identified patients with kidney cancer treated with LPN or OPN from 2000 through 2007. We then used Medicare claims to identify several postoperative outcomes, including ICU care, length of stay, rehospitalizations, operative mortality, and postoperative complications. We fit multivariable logistic regression models to estimate the association between each outcome and surgical approach (i.e., LPN vs. OPN), adjusting for patient and tumor characteristics. RESULTS: We identified 651 (28%) and 1,670 (72%) patients treated with LPN and OPN, respectively. Compared to those undergoing OPN, patients treated with LPN had a 34% lower probability of requiring ICU care (20.0% vs. 30.2%, p<0.001) and shorter median length of stay (3 vs. 5 days, p<0.001), with no differences observed in the likelihood of rehospitalization or operative mortality. While the frequency of postoperative complication was similar (35.5% vs. 36.1%, p=0.829), patients treated with LPN had a nearly two-fold greater probability of genitourinary complications and postoperative hemorrhage (p-values<0.001). CONCLUSIONS: At a population-level, patients with kidney cancer treated with LPN experienced a shorter and less intense hospitalization, supporting the benefits of laparoscopy. However, the greater likelihood of procedure-related complications highlights the need for continued efforts aimed at ensuring safe adoption and application of this advanced surgical technique.
Last Modified: 03 Sep 2013