Comparison of perioperative outcomes between open and minimally invasive nephroureterectomy: A population-based analysis

Sebastiano Nazzani, Amélie Bazinet, Felix Preisser, Elio Mazzone, Zhe Tian, Francesco A. Mistretta, Shahrokh F. Shariat, Fred Saad, Kevin C. Zorn, Emanuele Montanari, Alberto Briganti, Luca Carmignani, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To examine intraoperative and postoperative morbidity and mortality, as well as the impact on length of stay and total hospital charges of minimally invasive nephroureterectomy compared with open nephroureterectomy in patients with upper tract urothelial carcinoma. Methods: Within the National Inpatient Sample (2008–2013), we identified patients with non-metastatic upper tract urothelial carcinoma treated with either minimally invasive nephroureterectomy or open nephroureterectomy. We relied on inverse probability of treatment weighting to reduce the effect of inherent differences between open nephroureterectomy versus minimally invasive nephroureterectomy. Multivariable logistic regression, multivariable Poisson regression models and multivariable linear regression models were used. Results: Between 2008 and 2013, we identified 3897 patients treated with either minimally invasive nephroureterectomy (1093 [28%]) or open nephroureterectomy (2804 [72%]). In multivariable logistic regression models, minimally invasive nephroureterectomy resulted in lower rates of overall (odds ratio 0.71, P < 0.001), wound (odds ratio 0.49, P = 0.01), intraoperative (odds ratio 0.55, P = 0.01), miscellaneous surgical (odds ratio 0.64, P = 0.008) and miscellaneous medical complications (odds ratio 0.77, P = 0.002). Furthermore, minimally invasive nephroureterectomy was associated with lower rates of transfusions (odds ratio 0.61, P < 0.001). In multivariable Poisson regression models, minimally invasive nephroureterectomy was associated with shorter length of stay (relative risk 0.88, P < 0.001). Finally, higher total hospital charges ($2500 more per patient) were recorded for minimally invasive nephroureterectomy. Conclusions: Intraoperative and postoperative morbidity, as well as length of stay, but not total hospital charges favor minimally invasive nephroureterectomy over open nephroureterectomy. These outcomes validate the safety and feasibility of minimally invasive nephroureterectomy in select upper tract urothelial carcinoma patients.

Original languageEnglish
Pages (from-to)487-492
Number of pages6
JournalInternational Journal of Urology
Volume26
Issue number4
DOIs
Publication statusPublished - Apr 1 2019

Keywords

  • inverse probability of treatment weighting
  • nephroureterectomy
  • Surveillance, Epidemiology and End Results
  • upper urinary tract
  • urothelial carcinoma

ASJC Scopus subject areas

  • Urology

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