Surgeon characteristics and long-term trends in the adoption of laparoscopic radical nephrectomy.

Abstract

PURPOSE: We describe longitudinal trends in surgeon adoption of laparoscopic radical nephrectomy. We assessed whether this technique is associated with specific surgeon and/or practice setting characteristics. METHODS AND MATERIALS: We used Surveillance, Epidemiology and End Results-Medicare data to identify patients who underwent laparoscopic or open radical nephrectomy for early stage kidney cancer from 1995 through 2005. We assessed long-term trends in surgeon adoption of laparoscopic radical nephrectomy and fit multilevel logistic regression models to estimate the association between surgeon or practice setting characteristics and patient receipt of laparoscopic radical nephrectomy. RESULTS: The annual proportion of patients receiving laparoscopic radical nephrectomy increased from 1.4% in 1995 to 44.9% in 2005 (p <0.001). In patients treated by recent medical school graduates (graduation year 1991 or thereafter) the likelihood of undergoing laparoscopic radical nephrectomy was more than 2-fold higher when urologists practiced at National Cancer Institute designated Cancer Centers (OR 2.37, 95% CI 1.11-5.06) or in urban settings (OR 2.92, 95% CI 1.10-7.75). Patients treated by urologists who graduated before 1991 and had a major academic affiliation (OR 1.78, 95% CI 1.34-2.38) or were in a group practice (OR 1.99, 95% CI 1.51-2.63) were significantly more likely to be treated with a minimally invasive surgical approach than those treated in nonacademic and solo practices, respectively. CONCLUSIONS: Urologist adoption of laparoscopic radical nephrectomy increased progressively from 1995 through 2005 and was influenced by urologist proximity to training, academic affiliation and rural/urban status. These data clarify residual barriers to surgeon adoption of laparoscopic radical nephrectomy and potentially of other innovative surgical therapies.