Health Services ResearchContemporary Use of Partial Nephrectomy: Are Older Patients With Impaired Kidney Function Being Left Behind?
Section snippets
Materials and Methods
The study was approved by the Stanford University Institutional Review Board. Appropriate approvals were also obtained from Veterans Affairs Palo Alto Health Care System and individual data sources, where required.
Results
Table 1 describes the characteristics of the 14,024 patients who received a radical or partial nephrectomy in the VHA over the study period. Of these, 4499 (32%) underwent partial nephrectomy. The cohort was predominantly male (96.4%), with an average age of 64.4 years (median age 64 years, interquartile range 58 to 71). Patients typically presented with preoperative chronic kidney disease, with a mean preoperative eGFR of 71.6 mL/min/1.73 m2 (median 70.5 mL/min/1.73 m2, interquartile range
Discussion
Veterans treated in the VHA have worse physical and mental health compared with the general population, and may be more susceptible to loss of kidney function after kidney cancer surgery.16 Landrum et al demonstrated lower performance status and higher rates of severe comorbidity among cancer patients treated in the VHA.17 Despite caring for a complex patient population, data suggest that the VHA generally outperforms community care across a broad range of conditions. For example, after
Conclusion
Although the utilization of partial nephrectomy has increased over time for all groups in the VHA, the greatest increase has occurred in the youngest patients and those with the highest baseline kidney function. Older patients, and patients with impaired kidney function, were less likely to receive partial nephrectomy even though they potentially have the most to gain from the procedure.
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Financial Disclosure: John T. Leppert and Glenn M. Chertow received funding from NIDDK. The remaining authors declare that they have no relevant financial interests.