title: National trends and disparities in the use of minimally invasive adult pyeloplasty.
abstract: OBJECTIVE
  Minimally invasive pyeloplasty might have several advantages compared to open pyeloplasty in the management of ureteropelvic junction obstruction. Nonetheless, minimally invasive pyeloplasty appears to be underused in North America. We examined specific patient and hospital characteristics that may be associated with these disparities.
  
  
  METHODS
  The Nationwide Inpatient Sample was used to identify a national estimate of 29,456 patients with ureteropelvic junction obstruction treated with minimally invasive pyeloplasty (laparoscopic or robotic) and open pyeloplasty between 1998 and 2009. The rates of use of minimally invasive and open pyeloplasty were assessed according to year of surgery, and patient and hospital characteristics. The determinants of minimally invasive pyeloplasty were evaluated using logistic regression models adjusted for clustering.
  
  
  RESULTS
  Overall 15.3% of patients underwent minimally invasive pyeloplasty between 1998 and 2009. The use of minimally invasive pyeloplasty increased remarkably during the study period from 2.4% to 55.3%, a 23-fold increase. On multivariable logistic regression analysis African-American race (OR 0.584, p = 0.015) and other insurance status (including uninsured patients, OR 0.613, p = 0.013) were associated with a lower rate of minimally invasive pyeloplasty. Patients treated at teaching (OR 1.788, p = 0.003) and/or urban (OR 4.819, p <0.001) institutions were significantly more likely to undergo minimally invasive pyeloplasty.
  
  
  CONCLUSIONS
  In the last decade there has been a dramatic increase in the use of minimally invasive pyeloplasty in the United States and in 2009 a slight majority underwent minimally invasive pyeloplasty. Nonetheless, treatment disparities exist. African-American patients with other insurance status (including those uninsured) treated at nonteaching, rural hospitals were less likely to undergo minimally invasive pyeloplasty. Efforts should be made to understand these treatment disparities and broaden the availability of minimally invasive pyeloplasty.
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan 48202, USA.
authors: Shyam
authors: S
authors: Sukumar
authors: Maxine
authors: M
authors: Sun
authors: Pierre I
authors: PI
authors: Karakiewicz
authors: Ariella A
authors: AA
authors: Friedman
authors: Felix K
authors: FK
authors: Chun
authors: Jesse
authors: J
authors: Sammon
authors: Khurshid R
authors: KR
authors: Ghani
authors: Praful
authors: P
authors: Ravi
authors: Marco
authors: M
authors: Bianchi
authors: Wooju
authors: W
authors: Jeong
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Jens
authors: J
authors: Hansen
authors: James O
authors: JO
authors: Peabody
authors: Jack S
authors: JS
authors: Elder
authors: Mani
authors: M
authors: Menon
authors: Quoc-Dien
authors: QD
authors: Trinh
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D014481:United States; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends*