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. 2014 Aug;10(4):724-9.
doi: 10.1016/j.jpurol.2013.12.019. Epub 2014 Jan 22.

Variation in use of nephron-sparing surgery among children with renal tumors

David I Chu  1 , Jessica C Lloyd  1 , Zarine R Balsara  1 , John S Wiener  1 , Sherry S Ross  1 , Jonathan C Routh  2
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Variation in use of nephron-sparing surgery among children with renal tumors

David I Chu et al. J Pediatr Urol. 2014 Aug.

Abstract

Objective: Given the negative long-term effects of renal insufficiency, nephron-sparing surgery (NSS) is increasingly discussed for the treatment of pediatric renal tumors. We sought to examine variation in practice patterns of NSS among children with renal tumors.

Materials and methods: We performed a retrospective cohort analysis of claims data for pediatric inpatient admissions captured by the Kids Inpatient Database (1997-2009). We identified children with renal tumors who underwent surgery, including radical nephrectomy (RN) and NSS. We used multivariable logistic regression to assess the relationship between use of NSS and various clinical, demographic, and geographic predictors of interest.

Results: We identified 10,108 pediatric inpatient admissions for renal tumors. Of these, 1657 were surgical admissions, with 1501 patients (90.5%) undergoing RN and 156 (9.5%) undergoing NSS. On multivariable analysis, NSS was associated only with a concomitant diagnosis of renal insufficiency (relative ratio [RR] 3.37, p = 0.01) and surgery in the Northeastern USA (RR 3.07, p = 0.03). Race/ethnicity, age, payer type, procedure year, and other non-clinical factors were not significantly associated with NSS.

Conclusion: In a large, nationwide pediatric cohort, RN remains the most common surgical intervention for renal tumors. NSS is significantly associated with a diagnosis of renal insufficiency, but not non-clinical factors such as patient gender or race. © 2014 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.

Keywords: Kidney neoplasms; Nephrectomy; Pediatrics; Practice pattern variations.

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Regional trends in surgical procedures.
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