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06-09-2011 | Surgery | Article

Age, comorbidities affect in-hospital morbidity after kidney surgery


Free abstract

MedWire News: Older patients and those with high Charlson comorbidity scores are more likely to experience complications after a partial or radical nephrectomy (PN or RN), say researchers.

Overall, just over a third of all PN and RN patients will experience complications, including cardiac, pulmonary, vascular, wound/bleeding, and nephrectomy-specific events, they report in the Journal of Urology.

"The importance of our study is that it documents the morbidity of renal surgery on a population level," explain Robert Abouassaly (Case Western Reserve University, Cleveland, Ohio, USA) and colleagues.

"Most prior studies present data from centers of excellence and may not reflect morbidity in general clinical practice, where most patients are treated," they add.

Using data from the Canadian Institute for Health Information, the researchers determined associations between age and comorbidity on in-hospital surgical complications occurring in of 20,286 RN patients and 4292 PN patients.

The overall complication rate was 34.1% and 34.3% for RN and PN patients, respectively, and showed no associations with procedure type or patient income quintile, say Abouassaly et al.

As expected, rates of complication increased with age, notes the team, with patients aged 80 years or older having a 16.6% higher complication rate than those aged 50 years or younger.

Furthermore, three-quarters of patients with a Charlson score of 3 or 6 (n=557), where 6 indicates presence of metastatic solid tumors or AIDS, experienced complications, and had an overall 44% higher complication rate than patients with a score of 0.

While overall complication rates did not differ by treatment type, types of complications did, with RN patients more likely to have cardiac, respiratory, vascular, and miscellaneous surgical complications, and PN patients more often experiencing genitourinary and nephrectomy-specific complications.

However, this latter finding could be because of the "often complex reconstruction that is required after this procedure," write the researchers.

After multivariate logistic regression analysis of complications resulting from RN and PN, rates increased with increasing age and Charlson score. Specifically, patients aged 80 years or older had a 1.7- and 2.4-fold increase in the odds of a having a complication compared with their younger counterparts, and RN and PN patients with a Charlson score above 2 were a respective 6.2 and 5.7 times more likely to experience a complication than their counterparts with a score of 0.

"Clinicians must strongly consider the indications for surgery in these patient groups and weigh the substantial risk against the possibly slight benefit of treatment, particularly in patients with small, incidentally found renal masses," suggest Abouassaly and co-authors.

"In these patients at high risk, consideration should be given to less invasive treatment options such as thermal ablation or active surveillance," they conclude.

By Sarah Guy

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