Thirty-Day Mortality After Nephrectomy: Clinical Implications for Informed Consent

Vincent Cloutier, Umberto Capitanio, Laurent Zini, Paul Perrotte, Claudio Jeldres, Shahrokh F. Shariat, Philippe Arjane, Jean Jacques Patard, Francesco Montorsi, Pierre I. Karakiewicz

Research output: Contribution to journalArticle

Abstract

Background: The existing literature suggests that the surgical mortality (SM) observed with nephrectomy for localised disease varies from 0.6% to 3.6%. Objective: To examine age- and stage-specific 30-d mortality (TDM) rates after partial or radical nephrectomy. Design, setting, and participants: We relied on 24 535 assessable patients from the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) database. Measurements: In 12 283 patients, logistic regression models were used to develop a tool for pretreatment prediction of the probability of TDM according to individual patient and tumour characteristics. External validation was performed on 12 252 patients. Results and limitations: In the entire cohort of 24 535 patients, 219 deaths occurred during the initial 30 d after nephrectomy (0.9% TDM rate). TDM increased with age (≤49 yr: 0.5% vs 50-59 yr: 0.7% vs 60-69 yr: 0.9% vs 70-79 yr: 1.2% vs ≥80 yr: 2.0%; χ2 trend p <0.001) and stage (0.3% for T1-2N0M0 vs 1.3% for T3-4N0-2M0 vs 4.2% for T1-4N0-2M1; χ2 trend p = 2 trend p <0.001) and was lower after partial versus radical nephrectomy (RN) (0.4% vs 0.9%; p = 0.008). Only age (p <0.001) and stage (p <0.001) achieved independent predictor status. The look-up table that relied on the regression coefficients of age and stage reached 79.4% accuracy in the external validation cohort. Conclusions: Age and stage are the foremost determinants of TDM after nephrectomy. Our model provides individual probabilities of TDM after nephrectomy, and its use should be highly encouraged during informed consent prior to planned nephrectomy.

Original languageEnglish
Pages (from-to)998-1005
Number of pages8
JournalEuropean Urology
Volume56
Issue number6
DOIs
Publication statusPublished - Dec 2009

Keywords

  • 30-day mortality
  • Nephrectomy
  • Surgical mortality

ASJC Scopus subject areas

  • Urology

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    Cloutier, V., Capitanio, U., Zini, L., Perrotte, P., Jeldres, C., Shariat, S. F., Arjane, P., Patard, J. J., Montorsi, F., & Karakiewicz, P. I. (2009). Thirty-Day Mortality After Nephrectomy: Clinical Implications for Informed Consent. European Urology, 56(6), 998-1005. https://doi.org/10.1016/j.eururo.2008.11.023