National utilization of partial nephrectomy pre- and post- AUA guidelines: Is this as good as it gets?

Abstract Purpose To compare utilization and predictors of partial nephrectomy (PN) in the pre- and post- guideline eras. Methods American Board of Urology certification/recertification operative logs were reviewed from 2003-2014. Nephrectomy cases were extracted using Current Procedural Terminology (CPT) codes. The cases were then stratified by pre-guidelines (2003-Oct 2009) and post-guidelines (Nov 2009-2014). Multivariable logistic regression was used to evaluate patient, surgeon, and practice characteristics as predictors of PN. A general linear model with regression analysis was used to evaluate the change in PN over time relative to the incidence of renal cell carcinoma (RCC). Results We identified 20,402 and 20,729 nephrectomies in the pre- and post-guidelines era, respectively. On multivariable analysis, the post-guidelines group was more likely to undergo PN (OR 1.87, p