Partial nephrectomy found underused in poorer, sicker patients

Despite its well-established advantages over radical surgery, partial nephrectomy is not as likely to be used for older, sicker, and poorer patients who are uninsured or rely on Medicare or Medicaid for their health care, researchers from Henry Ford Hospital, Detroit reported here yesterday.

Using data from the Nationwide Inpatient Sample, researchers examined 375,986 U.S. kidney cancer patients who underwent either partial or radical nephrectomy from 1998 to 2009. Of those, 63,670 were partial nephrectomy patients.

During the study period, study authors found that the rate of partial nephrectomy grew nearly five times, from 6% of patients to 28%, said first author Quoc-Dien Trinh, MD, who worked on the study with Mani Menon, MD, and colleagues.

In multivariate analysis, advanced age and comorbidities were significantly associated with a lower rate of partial nephrectomy (pp≤.002). Patients living in the highest ZIP code income quartile were more likely to undergo partial nephrectomy (p=.001).

Those treated at high-volume and teaching institutions were significantly more likely to undergo a partial nephrectomy (both p

"We couldn’t adjust for such things as disease characteristics like tumor size, grade or location," Dr. Trinh said. "Also, it’s possible that these patients have inferior access to care, so present with worse disease, when partial nephrectomy isn’t feasible.

“However, it is also entirely possible that patients within this bracket are treated at hospitals that don’t have the proficiency to perform this advanced surgical technique."

If the disparities exist because of limited access, "then mechanisms need to be implemented to ensure that these patients receive higher quality care, and that they receive the appropriate treatment, namely partial nephrectomy, whenever possible," Dr. Trinh added.

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