Predictors of surgical approach for the management of renal cell carcinoma: a population‐based study from New South Wales

Abstract

The unintended decrease in PN associated with increased use of laparoscopic RN had reversed by 2009. Hospital case load predicts the use of PN and laparoscopy.

Changing trends in surgical management of renal tumours from 2000 to 2016: a nationwide study of Medicare claims data

“…We identified a progressive increase in the utilization of NSS in Australia over the past 15 years, consistent with smaller state‐based studies . While this could be due to a greater proportion of cases performed as PN in the private sector, as noted by Patel et al ., this trend is in keeping with multiple international studies . Specifically, a significant increase from 17% to 38% was observed between 2002 and 2014 in a Veterans Health cohort, which also described greatest and least uptake in younger and older patients, respectively, much like that observed in this study.…”

“…We identified a progressive increase in the utilization of NSS in Australia over the past 15 years, consistent with smaller state‐based studies . While this could be due to a greater proportion of cases performed as PN in the private sector, as noted by Patel et al ., this trend is in keeping with multiple international studies .…”

“…Reported factors that may influence PN use include patient characteristics such as younger age, less comorbidities, less complex tumour characteristics graded with scoring systems (e.g. RENAL nephrometry scoring system) and management factors such as high surgeon and/or hospital volume, urban and academic centre settings . Specifically in Australia, Patel et al .…”

Trends in the surgical management of stage 1 renal cell carcinoma: findings from a population‐based study

“…As we do not have data regarding the surgical management of small RCC tumours prior to 2009, we do not know whether use of NSS to treat T1a tumours was increasing during the 2000s, suggesting the increase we found between 2009 and 2013 was simply a continuation of this trend; however, Patel et al. showed that use of NSS for all RCC tumours was relatively stable between 2005 and 2008 at 20% in the Australian state of New South Wales. While not conclusive, this could suggest the increase in NSS found in the present study was in response to the publication of the international guidelines recommending use of NSS for small renal tumours.…”

“…Over the period of the present study, the proportion of patients treated in low‐volume hospitals decreased, while the proportion treated in middle‐volume hospitals increased. As several studies, including ours in univariable analyses, have shown a positive association between higher hospital renal cancer volumes and likelihood of NSS , this change is encouraging; however, unlike a recent European study that found no change in the use of NSS for T1 tumours in low‐volume hospitals , the present study found an increasing trend towards NSS for small renal tumours even in low‐volume hospitals. As our study used slightly different definitions for low‐volume hospitals, we repeated our analyses using the same volume definitions as those used in the European study , and found the same pattern of results as those presented in this paper.…”