Elsevier

Urology

Volume 124, February 2019, Pages 154-159
Urology

Oncology
Effect of the Need for Preoperative Dialysis on Perioperative Outcomes on Patients Undergoing Laparoscopic Nephrectomy: An Analysis of the National Surgical Quality Improvement Program Database

https://doi.org/10.1016/j.urology.2018.11.010Get rights and content

Abstract

Objective

To investigate whether patients requiring dialysis are a higher risk surgical population and would experience more perioperative adverse events even when undergoing a perceived less invasive operation as a laparoscopic radical nephrectomy (LRN). LRN is generally a well-tolerated surgical procedure with minimal morbidity and mortality. Prior to transplantation, dialysis patients will often have to undergo a LRN to remove a native kidney with a suspicious mass.

Materials and Methods

Patients in the American College of Surgeons National Surgical Quality Improvement Program who underwent a LRN between 2011 and 2016 were included. Patients were stratified by the need for preoperative dialysis 2 weeks prior to surgery, and perioperative outcomes were compared. A multivariable logistic regression analysis was performed to test the association between the need for preoperative dialysis and perioperative risk.

Results

There were 8315 patients included in this analysis of which 445 (5.4%) patients required preoperative dialysis. Patients who required preoperative dialysis had more minor (P <.0001) and major (P = .0025) complications, a higher rate of return to the operating room (P = .002), and a longer length of stay (P <.0001) than those patients not requiring preoperative dialysis. In a multivariate analysis, the need for preoperative dialysis was independently associated with adverse perioperative outcomes (OR= 1.45, CI = 1.08-1.95, P = .015).

Conclusion

Patients requiring preoperative dialysis were more likely to experience a perioperative complication and have a longer length of stay. For LRNs performed prior to transplantation, further risk stratification is needed, and treatment sequencing may need to be reconsidered.

Section snippets

Methods

Data for this study were obtained from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). The NSQIP database collects information from patients postsurgery from participating institutions. Postoperative complications, preoperative health data, and demographic information are collected to allow for complete analysis and outcome assessment. For this study, patients between the years 2011-2016 were identified by the Current Procedural Terminology code for

Results

Eight thousand three hundred fifteen patients were included in this analysis. Of the total cohort, 61.2% of the patients were male, and 85.9% were Caucasian. Stratified by the preoperative variable of needing dialysis 2 weeks prior to surgery, there were 445 (5.4%) patients who required preoperative dialysis while the remaining 7870 (94.6%) patients did not.

Significant differences existed between the 2 populations. (Table 1). Patients who were dialysis-dependent were more likely to be male (P

Discussion

Our study of 8315 patients who underwent a LRN revealed that patients needing preoperative dialysis had higher rates of adverse perioperative events compared to those patients not requiring preoperative dialysis. Statistically significant higher rates of minor and major complications were noted in the dialysis-dependent group. We also found higher rates of blood transfusions, unplanned reintubations, and unplanned return to the operating room in the 30-day postoperative period for the LRN

Conclusions

Our study of over 8000 patients appears to demonstrate that the dialysis-dependent patient population is complex and faces higher morbidity and mortality rates when compared to nondialysis-dependent patients undergoing a LRN. The true aggressiveness of ACD-associated RCC has not been well-defined but seems to be more indolent in nature compared to spontaneous renal masses in the non-ESRD population. With the higher surgical risks and possibly more indolent nature of renal masses in this patient

References (22)

  • L. Ozel et al.

    Elective and emergency surgery in chronic hemodialysis patients

    Ren Fail

    (2011)
  • View full text