title: Trends in renal surgery: robotic technology is associated with increased use of partial nephrectomy.
abstract: OBJECTIVE
  Underuse of partial vs radical nephrectomy for renal tumors was noted in recent population based analyses. An explanation is the learning curve associated with laparoscopic partial nephrectomy. We analyzed state trends in renal surgery and their relationship to the introduction of robotic technology.
  
  
  METHODS
  We used the Maryland HSCRC (Health Services Cost Review Commission) database to identify patients who underwent radical or partial nephrectomy, or renal ablation from 2000 to 2011. Utilization trends, and associated patient and hospital factors were analyzed using multivariate logistic regression. ICD-9 robotic modifier codes were established in October 2008.
  
  
  RESULTS
  Of the 14,260 patients included in analysis 11,271 (79.0%), 2,622 (18.4%) and 367 (2.6%) underwent radical and partial nephrectomy, and renal ablation, respectively. Partial nephrectomy increased from 8.6% in 2000 to 27% in 2011. Open radical nephrectomy decreased by 33%, while minimally invasive radical nephrectomy increased by 15%. Robot-assisted laparoscopic partial nephrectomy increased from 2008 to 2011, attaining a 14% rate at university and 10% at nonuniversity hospitals (p = 0.03). It was associated with increased partial nephrectomy (OR 9.67, p <0.001). Younger age, male gender and low patient complexity predicted partial nephrectomy on overall analysis, while higher hospital volume and university status were predictors only in earlier years.
  
  
  CONCLUSIONS
  Partial nephrectomy use increased in Maryland from 2001 to 2011, which was facilitated by robotic technology. Associations with hospital factors decreased with time. These data suggest that robotic technology may enable surgeons across practice settings to more frequently perform nephron sparing surgery.
authors.affiliation: James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
authors.forename: Hiten D
authors.initials: HD
authors.lastname: Patel
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Mullins
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Pierorazio
authors.forename: Gautam
authors.initials: G
authors.lastname: Jayram
authors.forename: Jason E
authors.initials: JE
authors.lastname: Cohen
authors.forename: Brian R
authors.initials: BR
authors.lastname: Matlaga
authors.forename: Mohamad E
authors.initials: ME
authors.lastname: Allaf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends*; D012371:Robotics; D013997:Time Factors; D055815:Young Adult