Management of renal cell carcinoma with ablation in comparison to nephrectomy: A 5-year analysis of inpatient procedural data to evaluate utilization disparities in the United States

Tarig S Elhakim; Taha Lodhi; Wilton Fidelis; Allison Brea; Ana Mort; Maryam Mohagheghtabar; Azadeh Tabari; Samuel R Davis; Raul N Uppot; Ronald S Arellano; Michael Dezube; Dania Daye

doi:10.1016/j.clinimag.2025.110412

Management of renal cell carcinoma with ablation in comparison to nephrectomy: A 5-year analysis of inpatient procedural data to evaluate utilization disparities in the United States

Clin Imaging. 2025 Jan 22:119:110412. doi: 10.1016/j.clinimag.2025.110412. Online ahead of print.

Authors

Tarig S Elhakim¹, Taha Lodhi², Wilton Fidelis³, Allison Brea⁴, Ana Mort⁵, Maryam Mohagheghtabar⁶, Azadeh Tabari⁷, Samuel R Davis⁸, Raul N Uppot⁷, Ronald S Arellano⁷, Michael Dezube⁸, Dania Daye⁷

Affiliations

¹ Massachusetts General Hospital, Boston, MA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: tarigelhakim@gmail.com.
² Brody School of Medicine, East Carolina University, Greenville, NC, USA.
³ Georgetown University School of Medicine, Washington, DC, USA.
⁴ Tufts University School of Medicine, Boston, MA, USA.
⁵ Saint Louis University School of Medicine, St. Louis, MO, USA.
⁶ Worcester State University, Worcester, MA, USA.
⁷ Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
⁸ Massachusetts General Hospital, Boston, MA, USA.

PMID: 39862649
DOI: 10.1016/j.clinimag.2025.110412

Abstract

Purpose: To perform a nationwide analysis of ablation compared to partial and total nephrectomy for the management of renal cell carcinoma (RCC) to evaluate utilization trends and disparities in the USA.

Materials and methods: The 2016-2020 National Inpatient Sample was analyzed. Using ICD-10, we identified the diagnosis of RCC then analyzed the utilization trends of ablation and nephrectomies (both partial and complete). To determine if any disparities exist, a multivariate logistic regression was performed to assess the influence of age, sex, race, income, payer, illness severity, geographical location, and hospital factors.

Results: From the 183,885 inpatient encounters with RCC, 3045 (1.65 %) underwent ablation, 70,080 (38.1 %) underwent partial nephrectomy, and 110,760 (60.2 %) underwent total nephrectomy. There was no significant difference in the sex between all groups. There was a statistically significant difference in the mean age of those undergoing ablation (67.30, SD = 12.05) versus those undergoing partial nephrectomy (59.27, SD = 13.26) and total nephrectomy (62.22, SD = 14.42) (OR: 1.04, 95%CI: 1.03-1.05, P < 0.001). Compared to White patients, Hispanic and African Americans were more likely to undergo ablation versus nephrectomy (OR: 1.52, 95%CI: 1.16-1.98, P = 0.002 and OR: 1.65, 95%CI: 1.28-2.13, P < 0.001, respectively). Compared to patients on private insurance, those on Medicaid and Medicare were more likely to have ablation than nephrectomy (OR: 1.85, 95%CI: 1.31-2.61, P < 0.001, and OR: 1.62, 95%CI: 1.26-2.08, P < 0.001, respectively). Furthermore, patients were less likely to undergo ablation than nephrectomies in 2020 compared to 2016 (OR: 0.69, 95%CI: 0.53-0.90, P = 0.006).

Conclusion: Since 2016, there has been a decreasing trend in the use of ablation for treating RCC in hospitalized patients. Those undergoing ablation tend to be older, African American, Hispanic, and insured by Medicare or Medicaid. Further research is needed to ensure equitable access for optimal treatment of RCC.

Keywords: Ablation; Disparities; Inequities; Nephrectomy; Renal cell carcinoma; Utilization trends.