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20-05-2012 | Surgery | Article

Postop renal complications confer high cost burden


Free abstract

MedWire News: Postoperative complications following renal surgery are associated with higher hospital costs, longer lengths of stay in hospital, and greater in-hospital mortality, indicate US study results.

The overall risk for complications after nephrectomy was around one in four, report the researchers, although it varied according to the type of surgery performed.

"With the national annual costs attributable to medical harm from hospitalization estimated at [US] $17 billion [€13 billion], postoperative complications have been identified as one of the leading contributors to higher healthcare costs," writes the team in BJU International.

Robert Houston Thompson (Mayo Clinic, Rochester, Minnesota) and colleagues used data from 2037 hospitals, recorded in the US Nationwide Inpatient Sample 2001‑2008, to assess the outcomes of 35,712 open radical nephrectomies (ORNs), 5327 laparoscopic radical nephrectomies (LRNs), and 8944 open partial nephrectomies (OPNs).

While the overall complication rate was 26.0%, the rate was lower after LRN and OPN, at 22.6% and 24.0%, compared with ORN, at 27.0%, remark Thompson et al.

In-hospital mortality rates followed a similar pattern, at 0.9% overall, but higher after ORN (1.1%) than after LRN (0.6%) or OPN (0.4%).

Furthermore, the types of complication affected in-hospital mortality. Any complication increased the risk for inpatient death; however, deep vein thrombosis/pulmonary embolism (DVT/PE) resulted in the greatest increase in risk for hospital death among ORN patients, while for LRN and OPN patients, infectious complications increased mortality risk the most.

Both the presence and type of complications also had a significant impact on hospitalization costs, increasing overall costs significantly. The highest costs by individual complication were for wound and infectious complications, at two to three times higher than for cases without these particular complications.

Length of hospital stay (LOS) was also significantly affected by complication rate and type; for example, among ORN cases, the probability of prolonged LOS (where the median was 5 days) was greater than 40% when the complication related to wound, infection, or DVT/PE.

Wound complications and DVT/PE also gave the highest predicted prolonged LOS for OPN, while only wound or infectious complications were associated with a greater than 40% chance of a prolonged stay in hospital.

"The present study has important implications for informing patients and urologists about the effect postoperative complications have on increasing the risk of poor outcomes and higher total costs for most types of nephrectomy," conclude Thompson and co-workers.

By Sarah Guy

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