title: Contemporary Use of Partial Nephrectomy: Are Older Patients With Impaired Kidney Function Being Left Behind?
abstract: OBJECTIVE
  To assess whether patient factors, such as age and preoperative kidney function, were associated with receipt of partial nephrectomy in a national integrated healthcare system.
  
  
  METHODS
  We identified patients treated with a radical or partial nephrectomy from 2002 to 2014 in the Veterans Health Administration. We examined associations among patient age, sex, race or ethnicity, multimorbidity, baseline kidney function, tumor characteristics, and receipt of partial nephrectomy. We estimated the odds of receiving a partial nephrectomy and assessed interactions between covariates and the year of surgery to explore whether patient factors associated with partial nephrectomy changed over time.
  
  
  RESULTS
  In our cohort of 14,186 patients, 4508 (31.2%) received a partial nephrectomy. Use of partial nephrectomy increased from 17% in 2002 to 32% in 2008 and to 38% in 2014. Patient race or ethnicity, age, tumor stage, and year of surgery were independently associated with receipt of partial nephrectomy. Black veterans had significantly increased odds of receipt of partial nephrectomy, whereas older patients had significantly reduced odds. Partial nephrectomy utilization increased for all groups over time, but older patients and patients with worse baseline kidney function showed the least increase in odds of partial nephrectomy.
  
  
  CONCLUSIONS
  Although the utilization of partial nephrectomy increased for all groups, the greatest increase occurred in the youngest patients and those with the highest baseline kidney function. These trends warrant further investigation to ensure that patients at the highest risk of impaired kidney function are considered for partial nephrectomy whenever possible.
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford Kidney Cancer Research Program, Stanford, CA. Electronic address: jleppert@stanford.edu.
authors.forename: John T
authors.initials: JT
authors.lastname: Leppert
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA.
authors.forename: Harsha R
authors.initials: HR
authors.lastname: Mittakanti
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA.
authors.forename: I-Chun
authors.initials: IC
authors.lastname: Thomas
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA.
authors.forename: Remy W
authors.initials: RW
authors.lastname: Lamberts
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA; Stanford Kidney Cancer Research Program, Stanford, CA.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Sonn
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA; Stanford Kidney Cancer Research Program, Stanford, CA.
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Chung
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA; Stanford Kidney Cancer Research Program, Stanford, CA.
authors.forename: Eila C
authors.initials: EC
authors.lastname: Skinner
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford Kidney Cancer Research Program, Stanford, CA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
authors.affiliation: Stanford Kidney Cancer Research Program, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA; Stanford Kidney Cancer Research Program, Stanford, CA.
authors.forename: James D
authors.initials: JD
authors.lastname: Brooks
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000473:pathology / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000706:statistics & numerical data*; D018579:Patient Selection; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014728:Veterans
chemical_list: D003404:Creatinine