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Keywords:

  • complications;
  • costs;
  • kidney cancer;
  • laparoscopy;
  • mortality;
  • outcome;
  • nephron-sparing surgery;
  • partial nephrectomy;
  • radical nephrectomy;
  • renal cell carcinoma

What's known on the subject? and What does the study add?

  • Postoperative complications for open radical nephrectomy (ORN), laparoscopic radical nephrectomy (LRN), and open partial nephrectomy (OPN) and its relationship with hospitalisation costs and mortality remain poorly described.
  • The present population-based study suggests modest differences in postoperative complications estimated at 27%, 23%, and 24% among patients with kidney cancer undergoing ORN, LRN, and OPN, respectively. Moreover, postoperative complications were associated with higher mortality, length of stay and total costs of hospitalisation.

Objectives

  • The association of complications after renal surgery for renal cell carcinoma (RCC) with in-hospital mortality and costs remains to be defined.
  • To describe the incidence of complications after open radical nephrectomy (ORN), laparoscopic RN (LRN), and open partial nephrectomy (OPN); and to evaluate its relationship with in-hospital mortality and total costs.

Patients and Methods

  • We identified 49 983 individuals who underwent ORN (35 712), LRN (5327), or OPN (8944) for RCC at 2037 hospitals from the Nationwide Inpatient Sample 2001–2008.
  • The outcomes assessed were in-hospital mortality and total hospitalisation costs.
  • Multivariable logistic regression and generalised estimating equations were used to test the associations between complications and in-hospital mortality and total costs.

Results

  • With 26.0% of patients experiencing postoperative complications, there were modest differences in the proportion of patients with complications after ORN, LRN, and OPN at 27.0%, 22.6%, and 24.0%, respectively (P < 0.001).
  • After adjusting for patient and hospital variables, postoperative complications resulted in higher odds of in-hospital death for ORN (odds ratio [OR] 7.20; P < 0.001), LRN (OR 12.04; P < 0.001), and OPN (OR 7.82; P < 0.001).
  • Adjusted total costs also rose significantly with the presence of any postoperative complications compared with those without any complications for ORN ($21 242 vs $13 183; P < 0.001), LRN ($19 548 vs $12 555; P < 0.001), and OPN ($18 883 vs $12 098; P < 0.001).

Conclusions

  • With about a quarter of patients experiencing postoperative complications, adverse events for ORN, LRN, and OPN carry a significant risk of in-hospital death and higher total costs.
  • Efforts to reduce postoperative complications may correlate with substantial reductions in hospital mortality and total costs.