title: Population level assessment of hospital based outcomes following laparoscopic versus open partial nephrectomy during the adoption of minimally invasive surgery.
abstract: OBJECTIVE
  The comparative outcomes of laparoscopic and open partial nephrectomy remain incompletely defined. Therefore, we used population based data to examine resource use and short-term outcomes among patients with kidney cancer treated with laparoscopic vs open partial nephrectomy.
  
  
  METHODS
  Using linked SEER (Surveillance, Epidemiology, and End Results)-Medicare data we identified patients with kidney cancer treated with laparoscopic or open partial nephrectomy from 2000 through 2007. We then used Medicare claims to identify several postoperative outcomes including intensive care unit care, length of stay, rehospitalizations, operative mortality and postoperative complications. We fit multivariate logistic regression models to estimate the association between each outcome and surgical approach (ie laparoscopic partial nephrectomy vs open partial nephrectomy), adjusting for patient and tumor characteristics.
  
  
  RESULTS
  We identified 651 (28%) and 1,670 (72%) patients treated with laparoscopic partial nephrectomy and open partial nephrectomy, respectively. Compared to those who underwent open partial nephrectomy, patients treated with laparoscopic partial nephrectomy had a 34% lower probability of requiring intensive care unit time (20.0% vs 30.2%, p <0.001) and shorter median length of stay (3 vs 5 days, p <0.001), with no differences observed in the likelihood of rehospitalization or operative mortality. While the frequency of postoperative complications was similar (35.5% vs 36.1%, p = 0.829), patients treated with laparoscopic partial nephrectomy had a nearly twofold greater probability of genitourinary complications and postoperative hemorrhage (p <0.001).
  
  
  CONCLUSIONS
  At a population level the patients with kidney cancer treated with laparoscopic partial nephrectomy experienced a shorter and less intense hospitalization, supporting the benefits of laparoscopy. However, the greater likelihood of procedure related complications highlights the need for continued efforts aimed at ensuring the safe adoption and application of this advanced surgical technique.
authors.affiliation: Department of Urology, University of California Los Angeles, Los Angeles, California.
authors.forename: Hung-Jui
authors.initials: HJ
authors.lastname: Tan
authors.affiliation: Michigan Center for Minimally Invasive Urology, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
authors.affiliation: Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Zaojun
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Khaled S
authors.initials: KS
authors.lastname: Hafez
authors.affiliation: Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan; University of Michigan Center for Healthcare Outcomes & Policy, Ann Arbor, Michigan. Electronic address: dcmiller@umich.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009392:Nephrectomy / Q000379:methods*; D017063:Outcome Assessment, Health Care
keywords: hospital mortality; kidney neoplasms; laparoscopy; length of stay; nephrectomy