Adoption of laparoscopic radical nephrectomy in the state of Washington

Jonathan D Harper, E Sophie Spencer, Michael P Porter, John L Gore
Urology 2012, 79 (2): 326-31

OBJECTIVE: To examine state-wide trends in adoption of laparoscopic radical nephrectomy (LRN). Open radical nephrectomy and LRN confer equivalent long-term oncological outcomes, yet LRN usage has not increased analogous to diffusion of laparoscopy in other fields.

MATERIAL AND METHODS: From the Washington State Comprehensive Hospital Abstract Reporting System, we identified patients who underwent ORN and LRN from 1998 to 2007. Number of LRNs was examined for each hospital state-wide. Length of stay outcomes were examined, and multivariate models were created to examine characteristics of LRN patients and of patients who received care at high-volume LRN hospitals (HiLap).

RESULTS: The proportion of nephrectomies performed laparoscopically increased 27%. In 1998, 7 hospitals (12%) performed≥1 LRN compared with 36 hospitals (61%) in 2007. Four HiLap hospitals accounted for 61% of the increase in LRN from 1998-2002, and 36% of the increase overall. Women (OR 1.15, 95% CI 1.00-1.33) and healthier patients (OR 1.52, 95% CI 1.28-1.82 for patients with Charlson 0 vs ≥2) were more likely to undergo LRN. Mean length of stay for nephrectomies was shorter at HiLap hospitals (P=.04 for 1998-2002, P<.001 for 2003-2007).

CONCLUSIONS: Uptake of LRN in Washington state parallels national trends; however, the proportion of LRN is lower than expected. A handful of hospitals account for the majority of the increase in LRN. The quality of nephrectomy care may be better at these centers. Barriers exist that prevent LRN adoption even after a trial case. Dissemination of the processes or personnel associated with use of LRN may increase the proportion of patients undergoing LRN.

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