title: Trends in partial and radical nephrectomy: an analysis of case logs from certifying urologists.
abstract: OBJECTIVE
  Surgical treatment options for renal masses include radical vs partial nephrectomy and the open vs laparoscopic approach. Using American Board of Urology (ABU) case log data, we investigated contemporary trends in these treatment options, and how surgeon and practice characteristics may influence these trends.
  
  
  METHODS
  Annualized case log data for nephrectomy were obtained from the ABU for all urologists certifying or recertifying from 2002 to 2010. We evaluated trends in nephrectomy use. Logistic regression was used to evaluate surgeon and practice characteristics as predictors of partial and laparoscopic procedures.
  
  
  RESULTS
  From the 3,852 case logs submitted by nonpediatric urologists we analyzed a total of 48,384 nephrectomies. From 2002 to 2010 the proportion of annual nephrectomies performed as open radical nephrectomy gradually decreased from 54% to 29%. During the same period, there was a moderate gradual increase in laparoscopic radical nephrectomies (from 30% to 39%). The proportion of open partial nephrectomies remained stable at 15%, while laparoscopic partial nephrectomy increased from 2% to 17%. On multivariable analysis the use of partial nephrectomy and laparoscopy was predicted by urologist annual nephrectomy volume, initial or recertification status, subspecialty, practice area size and geographic region.
  
  
  CONCLUSIONS
  Since 2002, the use of laparoscopic nephrectomy and partial nephrectomy has increased. However, the diffusion of these techniques is not uniform. Initial certification, higher surgical volume, and practicing in areas with more than 1,000,000 population and in the Northeast region were associated with greater use of laparoscopy and partial nephrectomy. Factors that affect the adoption of these techniques require further research.
authors: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. poons@mskcc.org
authors: Stephen A
authors: SA
authors: Poon
authors: Jonathan L
authors: JL
authors: Silberstein
authors: Ling Y
authors: LY
authors: Chen
authors: Behfar
authors: B
authors: Ehdaie
authors: Philip H
authors: PH
authors: Kim
authors: Paul
authors: P
authors: Russo
mesh_terms: D002568:Certification; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000639:trends; D016015:Logistic Models; D009392:Nephrectomy / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D014481:United States; D014572:Urology / Q000639:trends*
keywords: LPN; LRN; NSS; OPN; ORN; PN; RN; RP; kidney; kidney neoplasms; laparoscopic PN; laparoscopic RN; laparoscopy; nephrectomy; nephron sparing surgery; open PN; open RN; partial nephrectomy; physician's practice patterns; radical nephrectomy; radical prostatectomy