Trends and costs of minimally invasive surgery for kidney cancer in the US: A population-based study

Francesco Ditonno; Antonio Franco; Celeste Manfredi; Morgan R Sturgis; Carol L Feng; Daniel F Roadman; Spencer M Mossak; Eugenio Bologna; Leslie C Licari; Cosimo De Nunzio; Nicholas J Corsi; Craig Rogers; Firas Abdollah; Alessandro Antonelli; Edward E Cherullo; Ephrem Olweny; Riccardo Autorino

doi:10.1016/j.urology.2024.03.038

Trends and costs of minimally invasive surgery for kidney cancer in the US: A population-based study

Urology. 2024 Apr 24:S0090-4295(24)00278-4. doi: 10.1016/j.urology.2024.03.038. Online ahead of print.

Authors

Francesco Ditonno¹, Antonio Franco², Celeste Manfredi³, Morgan R Sturgis⁴, Carol L Feng⁴, Daniel F Roadman⁴, Spencer M Mossak⁴, Eugenio Bologna⁵, Leslie C Licari⁵, Cosimo De Nunzio⁶, Nicholas J Corsi⁷, Craig Rogers⁷, Firas Abdollah⁷, Alessandro Antonelli⁸, Edward E Cherullo⁴, Ephrem Olweny⁴, Riccardo Autorino⁹

Affiliations

¹ Department of Urology, Rush University Medical Center, Chicago, IL, USA; Department of Urology, University of Verona, Verona, Italy.
² Department of Urology, Rush University Medical Center, Chicago, IL, USA; Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy.
³ Department of Urology, Rush University Medical Center, Chicago, IL, USA; Urology Unit, Department of Woman, Child and General and Specialized Surgery, "Luigi Vanvitelli" University, Naples, Italy.
⁴ Department of Urology, Rush University Medical Center, Chicago, IL, USA.
⁵ Department of Urology, Rush University Medical Center, Chicago, IL, USA; Urology Unit, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital.
⁶ Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy.
⁷ VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA.
⁸ Department of Urology, University of Verona, Verona, Italy.
⁹ Department of Urology, Rush University Medical Center, Chicago, IL, USA. Electronic address: ricautor@gmail.com.

PMID: 38670274
DOI: 10.1016/j.urology.2024.03.038

Abstract

Objective: To analyze temporal trends and costs associated with the use of minimally invasive surgery (MIS) for kidney cancer in the US over the past decade. To examine the impact of social determinants of health (SDOH) on perioperative outcomes.

Methods: The PearlDiver Mariner, a national database of insurance billing records, was queried for this retrospective observational cohort analysis. The MIS population was identified and stratified according to treatment modality, using International Classification of Diseases (ICD) and current procedural terminology (CPT) codes. SDOH were assessed using ICD codes. Negative binomial regression was used to evaluate the overall number of renal MIS and Cochran-Armitage tests to compare the utilization of different treatment modalities, over the study period. Multivariable logistic regression analysis identified predictors of perioperative complications.

Results: A total of 80,821 MIS for kidney cancer were included. Minimally invasive partial nephrectomy (MIPN) adoption as a fraction of total MIS increased significantly (slope of regression line, reg. = 0.026, p<.001). Minimally invasive radical nephrectomy (MIRN) ($26,9k±40,9k) and renal ablation (RA) ($18,9k±31,6k) were the most expensive and the cheapest procedure, respectively. No statistically significant difference was observed in terms of number of complications (p=.06) and presence of SDOH (p=.07) among the treatment groups. At multivariable analysis, patients with SDOH undergoing MIRN had higher odds of perioperative complications, while RA had a significantly lower probability of perioperative complications.

Conclusions: This study describes the current management of kidney cancer in the US, offering a socioeconomic perspective on the impact of this disease in everyday clinical practice.

Data availability: Raw data generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.