title: Population-level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer.
abstract: BACKGROUND
  Because there is limited population-based evidence supporting the comparative effectiveness of laparoscopic radical nephrectomy (LRN) after its widespread adoption, we compared trends in hospital-based outcomes among patients with kidney cancer treated with LRN or open radical nephrectomy (ORN).
  
  
  METHODS
  Using linked SEER-Medicare data, the authors identified patients with kidney cancer who were treated with LRN or ORN from 2000 through 2005. The authors measured 4 primary outcomes: intensive care unit (ICU) admission, prolonged length of stay, 30-day hospital readmission, and in-hospital mortality. The authors then estimated the association between surgical approach and each outcome, adjusting for patient demographics, tumor characteristics, and year of surgery.
  
  
  RESULTS
  The authors identified 2108 (26%) and 5895 (74%) patients treated with LRN and ORN, respectively. Patients treated with LRN were more likely to be white, female, of higher socioeconomic position, and to have tumor sizes of ≤4 cm (all P < .05). The adjusted probability of ICU admission and prolonged length of stay was 41% and 46% lower, respectively, for patients undergoing LRN (P < .001). Although uncommon for both groups, the adjusted probability of in-hospital mortality was 51% higher (2.3% vs 1.5%, P = .04) for patients treated with a laparoscopic approach.
  
  
  CONCLUSIONS
  At a population level, patients treated with LRN have a lower likelihood of ICU admission and prolonged length of stay, supporting the convalescence benefits of laparoscopy. In-hospital mortality, however, was higher among patients treated with LRN. The latter finding suggests a potentially unanticipated consequence of this technique and highlights the need for long-term monitoring during and after the widespread adoption of new surgical technologies.
authors.affiliation: Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-2800, USA.
authors.forename: Hung-Jui
authors.initials: HJ
authors.lastname: Tan
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
authors.forename: Zaojun
authors.initials: Z
authors.lastname: Ye
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome