The effect of gender on nephrectomy perioperative outcomes: A national survey

Jesse Sammon, Quoc Dien Trinh, Maxine Sun, Marco Bianchi, Jan Schmitges, Shahrokh F. Shariat, Khurshid R. Ghani, Shyam Sukumar, Claudio Jeldres, Alberto Briganti, Paul Perrotte, Craig G. Rogers, James O. Peabody, Francesco Montorsi, Mani Menon, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: The effect of gender on complications after surgery is controversial. We examine the effect of gender on five short term nephrectomy outcomes. Materials and methods: Within the Health Care Utilization Project, Nationwide Inpatient Sample (NIS) we focused on nephrectomies performed within the most contemporary years (1998-2007). We tested the rates of blood transfusions, extended length of stay, in-hospital mortality, as well as intraoperative and postoperative complications, stratified according to gender. Multivariable logistic regression analyses fitted with general estimation equations for clustering among hospitals further adjusted for confounding factors. Separate multivariable analyses were performed for open radical nephrectomy (ORN), open partial nephrectomy (OPN), laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN). Results: Overall, 48172 nephrectomies were identified. Of those, female patients accounted 39.4% of cases (n = 18966). Female gender was associated with higher rates of blood transfusions (p <0.001) and higher rates of prolonged length of stay (p <0.001). Conversely, female gender was associated with lower rates of postoperative complications (p <0.001) and in-hospital mortality (p = 0.015). In multivariable analyses, female patients had higher rates of blood transfusion (OR = 1.22, p <0.001) but significantly lower rates of postoperative complications (OR = 0.81, p <0.001) and in-hospital mortality. No statistically significant differences were recorded for intraoperative complications and length of stay beyond the median (all p > 0.05). Gender as a predictor of outcomes was most pronounced in OPN and LPN. Conclusions: Nephrectomies performed in female patients are associated with lower rates of postoperative complications and in-hospital mortality. Conversely, blood transfusions rates are higher in these patients. Gender disparities in perioperative outcomes are most pronounced after OPN.

Original languageEnglish
Pages (from-to)6337-6344
Number of pages8
JournalThe Canadian journal of urology
Volume19
Issue number4
Publication statusPublished - Aug 2012

Keywords

  • Gender
  • Kidney cancer
  • Morbidity
  • Nephrectomy

ASJC Scopus subject areas

  • Urology

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