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