The relationship of postoperative complications with in-hospital outcomes and costs after renal surgery for kidney cancer

Simon P Kim, Bradley C Leibovich, Nilay D Shah, Christopher J Weight, Bijan J Borah, Leona C Han, Stephen A Boorjian, R Houston Thompson
BJU International 2013, 111 (4): 580-8

UNLABELLED: 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.

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