title: Association of type of renal surgery and access to robotic technology for kidney cancer: results from a population-based cohort.
abstract: OBJECTIVE
  To evaluate the relationship between partial nephrectomy (PN) and hospital availability of robot-assisted surgery from a population-based cohort in the USA.
  
  
  METHODS
  After merging the Nationwide Inpatient Sample (NIS) and the American Hospital Association survey from 2006 to 2008, we identified 21 179 patients who underwent either PN or radical nephrectomy (RN) for renal cell carcinoma (RCC). The primary outcome assessed was the type of nephrectomy performed. Multivariable logistic regression identified the patient and hospital characteristics associated with receipt of PN.
  
  
  RESULTS
  We identified 4832 (22.8%) and 16 347 (77.2%) patients who were treated for RCC with PN and RN, respectively. On multivariable analysis, patients were more likely to receive PN at academic centres (odds ratio [OR] 2.77; P < 0.001), urban centres (OR 3.66; P < 0.001) and American College of Surgeons (ACOS)-designated cancer centres (OR: 1.10; P < 0.05) compared with non-academic, rural and non-ACOS-designated cancer centre hospitals, respectively. Robot-assisted surgery availability at a hospital was also associated with a higher adjusted odds of PN compared with centres without that availability (OR 1.28; P < 0.001).
  
  
  CONCLUSIONS
  Although academic and urban locations are established factors that affect the receipt of PN for RCC, the availability of robot-assisted surgery at a hospital was also independently associated with higher use of PN. Our results are informative in identifying other key hospital characteristics which may facilitate greater adoption of PN.
authors.affiliation: Department of Urology, Public Policy and Effectiveness Research Center, New Haven, CT.
authors.forename: Steven V
authors.initials: SV
authors.lastname: Kardos
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Peter G
authors.initials: PG
authors.lastname: Schulam
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Weight
authors.forename: Jesse
authors.initials: J
authors.lastname: Sammon
authors.forename: Leona C
authors.initials: LC
authors.lastname: Han
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D018579:Patient Selection; D012371:Robotics; D016896:Treatment Outcome; D014481:United States
keywords: kidney cancer; outcomes; partial nephrectomy; radical nephrectomy; small renal masses; surgery