title: Evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the American Urologic Association guidelines for the management of clinical T1 renal masses.
abstract: BACKGROUND
  Partial nephrectomy has been underutilized in the United States. We investigated national trends in partial nephrectomy (PN) utilization before and after publication of the American Urological Association (AUA) Practice Guideline for management of the clinical T1 renal mass.
  
  
  METHODS
  We identified adult patients who underwent radical (RN) or PN from November 2007 to October 2011 in the Nationwide Inpatient Sample (NIS). PN prevalence was calculated prior to (11/2007-10/2009) and after Guidelines publication (11/2009-10/2011) and compared the rate of change by linear regression. We also examined the nephrectomy trends in patients with chronic kidney disease (CKD). Statistical analysis included linear regression to determine point-prevalence of PN rates in CKD patients and logistic regression to identify variables associated with PN.
  
  
  RESULTS
  During the study period, 30,944 patients underwent PN and 64,767 RN. The prevalence PN increased from 28.9% in the years prior to guideline release to 35.3% in the years following guideline release with an adjusted odds ratio (OR) of 1.24 (CI 1.01-1.54; p = 0.049). The rate of PN significantly increased throughout the study period (R2 0.15, p = 0.006): however, the rate of change was not increased after the guidelines. (p = 0.46). Overall rate of PN in patients with CKD did not increase over time (R2 0.0007, p = 0.99).
  
  
  CONCLUSIONS
  We noted a 6.4% absolute increase in PN after release of the AUA guidelines on clinical T1 renal mass was published; however, the rate of increase was not likely associated with guideline release. The rate of PN performed is increasing; however, further investigation regarding medical decision-making surrounding PN is needed.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.forename: Song
authors.initials: S
authors.lastname: Wang
authors.forename: Kerrin
authors.initials: K
authors.lastname: Palazzi
authors.forename: Ramzi
authors.initials: R
authors.lastname: Jabaji
authors.forename: Nishant
authors.initials: N
authors.lastname: Patel
authors.forename: Hak J
authors.initials: HJ
authors.lastname: Lee
authors.forename: J Kellogg
authors.initials: JK
authors.lastname: Parsons
authors.affiliation: Department of Urology, University of California San Diego Health System, La Jolla, CA, USA. iderweesh@gmail.com.
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D014481:United States