title: Trends in the surgical management of localized renal masses: thermal ablation, partial and radical nephrectomy in the USA, 1998-2008.
abstract: OBJECTIVE
  To evaluate the diffusion of nephron-sparing modalities (NSM) for the treatment of renal neoplasms in the USA over the last decade and to identify the factors associated with renal procedure selection.
  
  
  METHODS
  The Nationwide Inpatient Sample was utlized to identify patients undergoing cryo/radiofrequency ablation (C/RFA), radical nephrectomy (RN) and partial nephrectomy (PN) from 1998 to 2008. Annual trends in procedure prevalence were determined. Multivariate analyses were performed to query the influence of age, race, sex and comorbid disease on surgery selection.
  
  
  RESULTS
  We identified 443,853 procedures performed during the study period: 25,599 C/RFA, 79,568 PN and 338,687 RN. The prevalence per 100,000 hospital admissions in 1998 was 3.7 for C/RFA, nine for PN and 87.1 for RN. All procedures increased over the study period, by 1.05, 3.1 and 2.2/100,000 admissions per year, respectively (all P < 0.001). Diabetes, urban, teaching and large capacity hospitals were associated with NSM (either C/RFA or PN) compared to RN (all P ≤ 0.011). Age ≥70 years, female, hypertension, diabetes, chronic kidney disease (CKD) and region outside the Northeast favoured C/RFA over PN (all P ≤ 0.026). Compared to those without CKD, patients with CKD had an almost twofold higher probability of undergoing RN than NSM (odds ratio, 1.88; 95% confidence interval, 1.7-2.1). Despite increasing NSM utilization over the study period, most patients with CKD still received RN.
  
  
  CONCLUSIONS
  Although the prevalence of NSM is increasing, RN is more common. The low utilization of NSM in patients with pre-existing CKD warrants further investigation.
authors.affiliation: Division of Urology, University of California San Diego School of Medicine, La Jolla, CA 92093-0987, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Woldrich
authors.forename: Kerrin
authors.initials: K
authors.lastname: Palazzi
authors.forename: Sean P
authors.initials: SP
authors.lastname: Stroup
authors.forename: Roger L
authors.initials: RL
authors.lastname: Sur
authors.forename: J Kellogg
authors.initials: JK
authors.lastname: Parsons
authors.forename: David
authors.initials: D
authors.lastname: Chang
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
mesh_terms: D000367:Age Factors; D017115:Catheter Ablation / Q000379:methods / Q000706:statistics & numerical data*; D015897:Comorbidity / Q000639:trends; D003452:Cryosurgery / Q000379:methods / Q000706:statistics & numerical data*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States / Q000453:epidemiology