A description of radical nephrectomy practice and outcomes in England: 1995-2002.
OBJECTIVE
To describe national trends in the practice of radical nephrectomy (RN) in England between 1995 and 2002.


METHODS
Data were extracted from the Hospital Episode Statistics database of the Department of Health in England between 1995/1996 and 2001/2002. Patients were included in the study if an International Classification of Diseases diagnosis code (ICD-10) for malignant neoplasm of the kidney, renal pelvis or ureter, and an operative procedure code (OPCS-4) describing total or partial excision of the kidney by either a laparoscopic or open approach, were present in any of the diagnosis or operative procedure fields. Overall, 17 308 patients were included.


RESULTS
Patient age and the proportion who were men did not change over the study period. The proportion of patients admitted as an emergency decreased from 14.0% to 7.5% over this period (P < 0.001). The mean waiting duration increased by almost 6 days (P < 0.001) and length of stay by approximately 1 day, from 11.7 days in 1995 to 10.8 days in 2001 (P < 0.001). In-hospital mortality decreased from 2% to 1.5% (P = 0.134). In-hospital mortality and length of stay were higher in older patients and in those admitted as an emergency. Women had a longer stay than men (11.5 vs 11.1 days), but in-hospital mortality was higher in men (2.3% vs 1.6%). The national number of RNs per year increased by approximately 20%, from 2254 in 1995 to 2671 in 2001. Over the same period the mean annual hospital volume of RN increased by approximately 40%, from 17 in 1995 to 24 in 2001. The annual number of laparoscopic RNs nationally increased from seven in 1995 to 84 in 2002.


CONCLUSIONS
The annual number of RNs in England increased by almost a fifth and this was accompanied by an increase in annual hospital volume of about two-fifths. There was a large proportional increase in the number of laparoscopic RNs. Emergency admission rates and length of stay decreased but this was not accompanied by a significant change in in-hospital mortality rate.
Nuttall
Martin
M
Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
Cathcart
Paul
P
van der Meulen
Jan
J
Gillatt
David
D
McIntosh
Gregor
G
Emberton
Mark
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D010535:Laparoscopy / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000401:mortality / Q000706:statistics & numerical data*; D011364:Professional Practice / Q000706:statistics & numerical data*; D011379:Prognosis; D013997:Time Factors; D014516:Ureteral Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*