Higher perioperative morbidity and in-hospital mortality in patients with end-stage renal disease undergoing nephrectomy for non-metastatic kidney cancer: A population-based analysis

Jan Schmitges, Quoc Dien Trinh, Maxine Sun, Jens Hansen, Marco Bianchi, Claudio Jeldres, Paul Perrotte, Roland Dahlem, Shahrokh F. Shariat, Felix K. Chun, Francesco Montorsi, Mani Menon, Margit Fisch, Markus Graefen, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
JournalBJU International
Volume110
Issue number6B
DOIs
Publication statusPublished - Sep 2012

Keywords

  • chronic renal insufficiency
  • dialysis
  • nephrectomy
  • perioperative complications
  • renal cell carcinoma

ASJC Scopus subject areas

  • Urology

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