title: Variation in use of nephron-sparing surgery among children with renal tumors.
abstract: OBJECTIVE
  Given the negative long-term effects of renal insufficiency, nephron-sparing surgery (NSS) is increasingly discussed for the treatment of pediatric renal tumors. We sought to examine variation in practice patterns of NSS among children with renal tumors.
  
  
  METHODS
  We performed a retrospective cohort analysis of claims data for pediatric inpatient admissions captured by the Kids Inpatient Database (1997-2009). We identified children with renal tumors who underwent surgery, including radical nephrectomy (RN) and NSS. We used multivariable logistic regression to assess the relationship between use of NSS and various clinical, demographic, and geographic predictors of interest.
  
  
  RESULTS
  We identified 10,108 pediatric inpatient admissions for renal tumors. Of these, 1657 were surgical admissions, with 1501 patients (90.5%) undergoing RN and 156 (9.5%) undergoing NSS. On multivariable analysis, NSS was associated only with a concomitant diagnosis of renal insufficiency (relative ratio [RR] 3.37, p = 0.01) and surgery in the Northeastern USA (RR 3.07, p = 0.03). Race/ethnicity, age, payer type, procedure year, and other non-clinical factors were not significantly associated with NSS.
  
  
  CONCLUSIONS
  In a large, nationwide pediatric cohort, RN remains the most common surgical intervention for renal tumors. NSS is significantly associated with a diagnosis of renal insufficiency, but not non-clinical factors such as patient gender or race. © 2014 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.
authors: Division of Urologic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors: David I
authors: DI
authors: Chu
authors: Division of Urologic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors: Jessica C
authors: JC
authors: Lloyd
authors: Division of Urologic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors: Zarine R
authors: ZR
authors: Balsara
authors: Division of Urologic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors: John S
authors: JS
authors: Wiener
authors: Division of Urologic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors: Sherry S
authors: SS
authors: Ross
authors: Division of Urologic Surgery, Duke University Medical Center, Durham, NC 27710, USA. Electronic address: jonathan.routh@duke.edu.
authors: Jonathan C
authors: JC
authors: Routh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000379:methods / Q000706:statistics & numerical data*; D009399:Nephrons; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data*; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
keywords: Kidney neoplasms; Nephrectomy; Pediatrics; Practice pattern variations