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Is there a volume-outcome relationship for partial nephrectomy?

J-P Couapel1, K Bensalah, J-C Bernhard

  • 1Department of Urology, Chu Pontchaillou, Rennes, France, jp.couapel@yahoo.fr.

World Journal of Urology
|November 26, 2013
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Summary
This summary is machine-generated.

High-volume hospitals perform more partial nephrectomies (PN), especially for small renal masses. Moderate-volume centers showed increased positive margin and complication rates, potentially due to higher laparoscopy use.

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Area of Science:

  • Urology
  • Surgical Oncology
  • Health Services Research

Background:

  • Hospital volume is a critical factor influencing surgical outcomes.
  • Understanding the relationship between partial nephrectomy (PN) volume and clinical results is essential for optimizing patient care.

Purpose of the Study:

  • To assess how hospital volume affects the indications for and outcomes of partial nephrectomy (PN).

Main Methods:

  • Data from 570 partial nephrectomies across 53 centers were analyzed.
  • Centers were categorized into very high (VH), high (H), moderate (M), and low (L) volume groups based on PN procedures performed.
  • Multivariable analysis examined the impact of hospital volume on complications and positive margin rates.

Main Results:

  • Higher volume centers treated younger patients with lower BMI and ASA scores.
  • Partial nephrectomy was more common in high-volume centers, particularly for small renal masses (<4 cm).
  • Moderate volume centers exhibited higher positive margin and complication rates, possibly linked to increased laparoscopic PN use.

Conclusions:

  • Partial nephrectomy is more frequently indicated in high-volume institutions, especially for small renal masses.
  • Moderate volume centers demonstrated elevated rates of positive margins and complications, potentially associated with greater adoption of laparoscopic techniques.