title: Does partial nephrectomy at an academic institution result in better outcomes?
abstract: OBJECTIVE
  Partial nephrectomy (PN) outcomes may be better at academic institutions than at non-academic centers. Peer-review, sub-specialized practice profile, higher individual surgeon and institutional caseload may explain this observation. To the best of our knowledge, the role of institutional academic affiliation has not been examined with regard to PN postoperative outcomes.
  
  
  METHODS
  Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on PNs performed within the 10 most contemporary years (1998-2007). We explored the effect of academic status on three short-term PN outcomes (intraoperative and postoperative complications, as well as in-hospital mortality). Multivariable logistic regression analyses further adjusted for age, race, gender, Charlson Comorbidity Index (CCI), surgical approach, hospital region, annual hospital caseload and insurance status.
  
  
  RESULTS
  Overall, 8,513 PNs were identified. Of those, 5,906 (69.4%) were recorded at academic institutions. Academic institution patients had lower CCI, were less frequently Caucasian and more frequently had private insurance (all P < 0.001). Academic institution PNs were associated with fewer postoperative complications (14.6% vs. 16.6%, P = 0.018). In multivariable analyses, institutional academic status did not affect the three short-term PN outcomes.
  
  
  CONCLUSIONS
  Patient selection explains better PN postoperative outcomes at academic institutions. Control for these biases removes the outcome differences, at least when the three short-term PN outcomes are considered. However, the interpretation of these findings needs to take into account the lack of adjustment for case complexity.
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA. trinh.qd@gmail.com
authors: Quoc-Dien
authors: QD
authors: Trinh
authors: Jan
authors: J
authors: Schmitges
authors: Maxine
authors: M
authors: Sun
authors: Jesse
authors: J
authors: Sammon
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Shyam
authors: S
authors: Sukumar
authors: Kevin
authors: K
authors: Zorn
authors: Marco
authors: M
authors: Bianchi
authors: Claudio
authors: C
authors: Jeldres
authors: Paul
authors: P
authors: Perrotte
authors: Markus
authors: M
authors: Graefen
authors: Craig G
authors: CG
authors: Rogers
authors: James O
authors: JO
authors: Peabody
authors: Mani
authors: M
authors: Menon
authors: Pierre I
authors: PI
authors: Karakiewicz
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult