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• W2034694898 abstract "No AccessJournal of UrologyAdult urology1 Feb 2006Use of Nephrectomy at Select Medical Centers—A Case of Follow the Crowd? Brent K. Hollenbeck, David A. Taub, David C. Miller, Rodney L. Dunn, and John T. Wei Brent K. HollenbeckBrent K. Hollenbeck More articles by this author , David A. TaubDavid A. Taub More articles by this author , David C. MillerDavid C. Miller More articles by this author , Rodney L. DunnRodney L. Dunn More articles by this author , and John T. WeiJohn T. Wei Financial interest and/or other relationship with Sanofi, Laserscope, Calypso and Boehringer Ingelheim. More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)00146-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Regionalization of high risk surgical procedures to larger, teaching hospitals has been suggested as a means to improve the quality of care. We determined the extent to which the regionalization of nephrectomy has occurred and describe the potential causes and implications of any observed regionalization. Materials and Methods: The Nationwide Inpatient Sample comprises a 20% sampling of hospital discharges in the United States yearly. Patients undergoing nephrectomy for kidney cancer between 1988 and 2002 were identified using International Classification of Disease, Ninth Revision, Clinical Modification codes. Regionalization was assessed using 6 structural hospital measures, including teaching status, urban location, discharge volume, nephrectomy volume, bed capacity and for-profit status. Adjusted models were developed to identify the significance of temporal trends in each regionalization measure. Results: We identified 66,621 patients undergoing nephrectomy during the study period. Compared to procedures performed between 1988 and 1990 the likelihood of undergoing nephrectomy at teaching, high nephrectomy volume and high throughput (all diagnoses) hospitals increased by 2.0 (CI 1.9 to 2.2), 7.4 (CI 7.1 to 7.7) and 2.2 times (CI 2.1 to 2.2), respectively, in 2000 to 2002. Conversely nephrectomy was less likely to be performed at for-profit hospitals (OR 0.5, CI 0.5 to 0.6). Patients were more likely to undergo partial nephrectomy at teaching, high volume, high throughput, urban hospitals. Conclusions: Regionalization of nephrectomy to teaching and high volume (nephrectomy and all diagnoses) hospitals is currently under way. Although the implications are not entirely clear, this study provides further evidence for the crowding of complex surgical procedures into these institutions. References 1 : Should we regionalize major surgery? Potential benefits and policy considerations. J Am Coll Surg2000; 190: 341. 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Google Scholar Department of Urology and the Division of Clinical Research, the University of Michigan, Ann Arbor, Michigan© 2006 by American Urological AssociationFiguresReferencesRelatedDetailsCited byLaguna M (2018) Re: Benefit in Regionalization of Care for Patients Treated with Nephrectomy: A Nationwide Inpatient SampleJournal of Urology, VOL. 194, NO. 3, (664-665), Online publication date: 1-Sep-2015. Volume 175Issue 2February 2006Page: 670-674 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordshospitalsquality of health carecarcinomanephrectomyrenal cellteachingkidneyMetricsAuthor Information Brent K. Hollenbeck More articles by this author David A. Taub More articles by this author David C. Miller More articles by this author Rodney L. Dunn More articles by this author John T. Wei Financial interest and/or other relationship with Sanofi, Laserscope, Calypso and Boehringer Ingelheim. 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