BJU International, Sept, 2012, p.E183(8)
To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.10936.x/abstract Byline: Jan Schmitges(1)(3)(*), Quoc-Dien Trinh(3)(5)(*), Maxine Sun(3), Jens Hansen(1)(3), Marco Bianchi(7), Claudio Jeldres(3), Paul Perrotte(4), Roland Dahlem(2), Shahrokh F. Shariat(6), Felix K. Chun(2), Francesco Montorsi(7), Mani Menon(5), Margit Fisch(2), Markus Graefen(1), Pierre I. Karakiewicz(3) Keywords: dialysis; chronic renal insufficiency; perioperative complications; nephrectomy; renal cell carcinoma Study Type - Therapy (population cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Patients with renal failure more frequently harbour RCC due to predisposing factors such as cystic disease of the kidney. The benefit of nephrectomy might be outweighed by adverse perioperative events, however, which may be more prevalent in patients with end-stage renal disease (ESRD). In a population-based study focusing on patients after non-elective colorectal surgery, patients with ESRD had an increased risk of mortality and complications. To date, small-scale studies have reported complication rates in patients with ESRD after nephrectomy for RCC with conflicting results. However, no formal contemporary analysis has been compiled within a nephrectomy cohort of adequate size. The present population-based case-control study showed that patients with ESRD are at substantially higher risk of in-hospital mortality and in-hospital complications. Specifically, we demonstrated higher cardiac-related complications, transfusion and haemorrhage/haematoma rates in patients with ESRD than in others. Moreover, patients with ESRD are more likely to have prolonged length of stay in hospital, and incur higher hospital charges. Based on the findings of the present study, use of biopsy and active surveillance for small, carefully selected renal masses might be considered in patients with ESRD at high risk of morbidity and mortality after surgery. OBJECTIVE * To examine the effect of end-stage renal disease (ESRD) on six short-term nephrectomy outcomes. PATIENTS AND METHODS * The Nationwide Inpatient Sample was used to assess the rates of blood transfusions, intra-operative and postoperative complications, length of hospital stay (LOS) within the highest quartile (〉5 days), total hospital charges within the highest quartile (〉$33 391) and in-hospital mortality. * Propensity-based matching was performed to adjust for potential baseline differences between patients with ESRD and others. * Multivariable logistic regression analyses further adjusted for confounding variables. RESULTS * Overall, 46 225 patients underwent open radical, open partial, laparoscopic radical or laparoscopic partial nephrectomy for non-metastatic kidney cancer between 1998 and 2007. * Of those, 941 patients with ESRD were identified (2.0%). * For patients with ESRD and others, the following rates were recorded, respectively: blood transfusions, 17.4 vs 9.1% (P 0.001); intra-operative complications, 3.5 vs 3.3% (P= 0.81); postoperative complications, 19.2 vs 15.6% (P= 0.007); length of stay within the highest quartile, 55.4 vs 30.1% (P 0.001); total hospital charges within the highest quartile, 50.4 vs 26.3% (P 0.001); in-hospital mortality, 2.4 vs 0.5% (P 0.001). * In multivariable logistic regression analyses, patients with ESRD were more likely to receive a blood transfusion (odds ratio [OR]= 2.05, P 0.001), to experience any postoperative complication (OR = 1.25, P= 0.019), to have a LOS within the highest quartile (OR = 3.06, P 0.001), to have hospital charges within the highest quartile (OR = 3.10, P 0.001), and to die during hospitalization (OR = 4.85, P 0.001). CONCLUSIONS * Patients with ESRD are at substantially higher risk of adverse outcomes after nephrectomy. * Most importantly, the in-hospital mortality rate is fivefold higher. Author Affiliation: (1)Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf (2)Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (3)Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (4)Department of Urology, University of Montreal Health Center, Montreal, QC, Canada (5)Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (6)Weill Medical College of Cornell University, New York, NY, USA (7)Department of Urology, Vita Salute San Raffaele University, Milan, Italy Correspondence: (*) Jan Schmitges, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal, QC, Canada H2X 3J4. e-mail: firstname.lastname@example.org Article Note: (*) These authors contributed equally to this work. Accepted for publication 9 November 2011
Cancer -- Complications And Side Effects ; Cancer -- Patient Outcomes ; Cancer -- Analysis ; Chronic Kidney Failure -- Complications And Side Effects ; Chronic Kidney Failure -- Patient Outcomes ; Chronic Kidney Failure -- Analysis ; Mortality -- Analysis ; Cancer Metastasis -- Complications And Side Effects ; Cancer Metastasis -- Patient Outcomes ; Cancer Metastasis -- Analysis
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