Session: MP64: Kidney Cancer: Epidemiology & Evaluation/Staging/Surveillance III
MP64-15: From Northeast to West: Patient and Hospital Characteristics Affecting Access to Partial Nephrectomy in the United States as Stratified by Geographic Location
Resident Physician Einstein Healthcare Network, Philadelphia, PA
Introduction: Partial nephrectomy (PN) is considered the gold standard treatment of small renal masses (SRM). With the recent changes in prevalence of open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN), access to care remains a point of interest. Herein, we examine the trends in surgical approach for PN through a geographic lens. Methods: ICD and CPT codes were used to identify patient diagnoses and characteristics of PN encounters between January 1, 2000 and December 31, 2019 from the Premier Healthcare Database, a de-identified database with over 1,041 contributing hospitals/healthcare systems. We examined patient social, surgical, and hospital characteristics. Multivariable logistic regression models were used. All statistical tests were two-sided (p-value=0.05 significant). Results: Out of 42,762 surgeries, 12,856 (30.1%) were OPN and 29,906 (69.9%) were RPN. In the Northeast, non-Hispanic Black patients were more likely to receive RPN as compared to non-Hispanic White patients (OR=1.27 [95%CI=1.06-1.54] p=0.004). This was not the case in the South, Midwest, and West regions (0.91 [0.83-1.01] p=0.018; 0.93 [0.71-1.12] p=0.018; and 0.81 [0.56-1.17] p=0.031, respectively). Medicaid patients were less likely to receive RPN as compared to HMO/PPO patients in the Northeast and South (0.67 [0.56-0.79] p=0.002; 0.70 [0.70-0.81] p=0.004). In the Northeast, patients at urban hospitals were more likely to undergo RPN as compared to rural hospitals (3.55 [2.94-4.29] p < 0.001) while the reverse was true in the West (0.45 [0.33-0.62 p<0.001). Across all geographic regions, there was a lower proportion of patients at high volume hospitals receiving RPN as compared to low volume hospitals. Conclusions: As RPN increases in prevalence in the management of the SRM, access to this surgical approach is influenced by a variety of patient and hospital characteristics. While certain hospital characteristics hold true across the United States in regard to hospital and surgeon volume, patient characteristics affecting receipt of RPN vary between geographic divisions. These differences can serve as a starting point for further analysis to address factors limiting access to urologic care. SOURCE OF Funding: NA
