title: Evaluation of the charges, safety, and mortality of percutaneous renal thermal ablation using the nationwide inpatient sample.
abstract: OBJECTIVE
  To perform a national analysis of safety, charges, complications, and mortality of percutaneous image-guided renal thermal ablation and compare outcomes by hospital volume.
  
  
  METHODS
  Using the Nationwide Inpatient Sample, trends in the proportion of inpatient percutaneous renal thermal ablation procedures performed at high-volume centers in the United States from 2007-2011 were evaluated. In-hospital mortality, discharge to long-term care facility, length of stay, hospitalization charges, and postoperative complications were compared between high-volume and low-volume ablation centers. High volume was set at the 90th percentile for renal thermal ablation volume, which equated to seven or more patients per year. A multivariate logistic regression analysis adjusting for hospital volume, age, sex, Charlson Comorbidity Index, obesity, race, and insurance status was performed to analyze the influence of hospital volume on the above-listed outcomes.
  
  
  RESULTS
  This study included 874 patients. The number of hospitals ranged from 59-77 depending on year. Overall, 328 patients (37.5%) were treated at high-volume ablation centers. The proportion of patients treated at high-volume centers decreased from 42.0% in 2007-2009 to 28.5% in 2010-2011. High-volume hospitals also performed significantly more partial nephrectomies than low-volume hospitals. On multivariate logistic regression analysis, increasing hospital volume was associated with lower odds of in-hospital mortality (odds ratio [OR] = 0.31, 95% confidence interval [CI] = 0.02-0.95) and lower odds of discharge to a long-term care facility (OR = 0.00, 95% CI = 0.00-0.66). Increasing hospital volume was also associated with lower odds of blood transfusion (OR = 0.84, 95% CI = 0.72-0.94). Length of stay decreased with increasing hospital volume (P = .03).
  
  
  CONCLUSIONS
  Patient safety may be maximized when renal ablation is performed at high-volume centers as a result of both greater procedural experience and potentially multidisciplinary triage and periprocedural management.
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Electronic address: welch.brian@mayo.edu.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Welch
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
authors.forename: Grant D
authors.initials: GD
authors.lastname: Schmit
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
authors.forename: A Nicholas
authors.initials: AN
authors.lastname: Kurup
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
authors.forename: Abdulrahman M
authors.initials: AM
authors.lastname: El-Sayed
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Cloft
authors.affiliation: Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
authors.forename: R Houston
authors.initials: RH
authors.lastname: Thompson
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Callstrom
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Atwell
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D006979:Hyperthermia, Induced / Q000401:mortality* / Q000706:statistics & numerical data; D015994:Incidence; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D018570:Risk Assessment; D018401:Sample Size; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology