Temporal improvements in renal surgery outcomes across surgical approaches

Abstract

Purpose

To evaluate patient outcomes in a contemporary cohort of patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN).

Methods

The NSQIP database was used to identify patients undergoing PN or RN for renal neoplasms between 2010 and 2018. The SEER database was also queried to assess changes in tumor staging during the study period. Logistic regression was used to assess the independent relationship between surgery year and approach on postoperative complications.

Results

Between 2010 and 2018, NSQIP captured 58,020 cases, including 26,745 (46%) PN and 31,275 (54%) RN. The proportion of PN increased annually, from 39.8% in 2010 to 48.7% in 2018. This rise in PN coincided with a decrease in the proportion of patients experiencing complications, irrespective of surgical approach (20.4% of total cases to 14.2% of total cases). While limited by a lack of information on tumor characteristics, multivariable analysis controlling for patient characteristics demonstrated that RN was associated with an increased risk of complications, OR 1.42 (95% CI 1.35–1.49).

Conclusion

Here, we report an 8.9% increase in the proportion of patients undergoing PN between 2010 and 2018, with no associated increase in perioperative morbidity/mortality. Given that there was no concurrent shift in stage or size of kidney tumors undergoing resection during the study period, these data therefore suggest markedly improved surgical technique and perioperative management nationally. Furthermore, the relative burden of complications has shifted from patients undergoing PN to those undergoing RN. Therefore PN, when technically feasible, should be increasingly considered.

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Abbreviations

ACS:

American College of Surgeons

ARF:

Acute Renal Failure

ASA:

American Society of Anesthesiologists

AUA:

American Urological Association

BMI:

Body Mass Index

CCI:

Charlson Comorbidity Index

CHF:

Congestive Heart Failure

CKD:

Chronic Kidney Disease

COPD:

Chronic obstructive pulmonary disease

CPT:

Current Procedural Terminology

DM:

Diabetes Mellitus

HTN:

Hypertension

MI:

Myocardial Infarction

NSQIP:

National Surgical Quality Improvement Program (NSQIP)

PE:

Pulmonary embolism

PN:

Partial Nephrectomy

PNA:

Pneumonia

RN:

Radical Nephrectomy

SEER:

Surveillance, Epidemiology and End Results

SRM:

Small Renal Mass

UTI:

Urinary Tract infection

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Funding

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. There are no funding sources to disclose.

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Authors

Contributions

KG: protocol/project development, data collection, data analysis, manuscript writing/editing. DO-L: protocol/project development, data collection, data analysis, manuscript writing/editing. DS: Manuscript editing. JS: Protocol/project development, manuscript editing. KG and DO-L authors share first authorship with equal contribution to the current study.

Corresponding author

Correspondence to Karishma Gupta.

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Conflict of interest

The authors have no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article.

Research involving human participants and/or animals

Neither human nor animal participants were recruited for this study. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a nationally validated, risk-adjusted, outcomes-based database used to measure and improve the quality of surgical care. Data are retrospective de-identified variables regarding surgical procedures and outcomes. Therefore, the University Hospitals Cleveland Medical Center (UH CMC) Institutional Review Board granted an exemption for this study. The IRB exemption protocol was approved on August 26, 2020.

Informed Consent

Informed consent was not required for this study given the utilization of retrospective de-identified variables. The University Hospitals Cleveland Medical Center (UH CMC) Institutional Review Board granted an exemption for this study on August 26, 2020.

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Gupta, K., Omil-Lima, D., Sheyn, D. et al. Temporal improvements in renal surgery outcomes across surgical approaches. Int Urol Nephrol (2021). https://doi.org/10.1007/s11255-021-02811-z

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Keywords

  • Renal neoplasms
  • Partial nephrectomy
  • Radical nephrectomy
  • National surgical quality improvement program