Trends in the use of gross and frozen section pathological consultations during partial or radical nephrectomy for renal cell carcinoma.
OBJECTIVE
There is no consensus regarding the role of intraoperative pathological consultation during kidney cancer surgery. Accordingly intraoperative pathological consultation use is susceptible to variation based on nonclinical factors. We explored this hypothesis by evaluating national trends in the use of intraoperative pathological consultation during radical or partial nephrectomy with time, across regions, and by patient and provider characteristics.


METHODS
Using linked Surveillance, Epidemiology and End Results-Medicare data we identified a cohort of patients who underwent partial or radical nephrectomy from 1991 to 2002. In each case we ascertained corresponding Medicare claims for gross and/or frozen section intraoperative pathological consultation. We assessed variations in the use of intraoperative pathological consultation by year of treatment and geographic region as well as by patient and provider characteristics.


RESULTS
We identified 7,507 cases treated with partial (600 or 8.0%) or radical (6,907 or 92.0%) nephrectomy from 1991 through 2002. Of cases treated with radical nephrectomy 744 (10.8%) and 843 (12.2%) received gross and frozen section intraoperative pathological consultation, respectively. Of cases treated with partial nephrectomy 67 (11.2%) had an intraoperative gross consultation and 323 (53.8%) had a frozen section evaluation. Use of intraoperative pathological consultation (gross or frozen section) during partial and radical nephrectomy varied based on patient demographics, United States Census region, and Surveillance, Epidemiology and End Results registry (p <0.05). Intraoperative pathological consultation during radical nephrectomy differed by year of treatment (p <0.05). Intraoperative pathological consultation use also varied based on provider characteristics (p <0.05).


CONCLUSIONS
Intraoperative pathological consultation use during kidney cancer surgery varies with time, across geographic regions and based on patient demographics and broadly defined provider characteristics. These data provide context for future studies seeking to refine the use of intraoperative pathological consultation in this clinical setting.
Miller
David C
DC
Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
Shah
Rajal B
RB
Bruhn
Aron
A
Madison
Rodger
R
Saigal
Christopher S
CS
D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005629:Frozen Sections / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D009392:Nephrectomy; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends*; D018426:SEER Program; D014481:United States