Who is at risk of death from nephrectomy? An analysis of thirty-day mortality after 21 380 nephrectomies in 3 years of the British Association of Urological Surgeons (BAUS) National Nephrectomy Audit.

Autor: Fernando A; British Association of Urological Surgeons, London, UK.; Urology Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK., Fowler S; Urology Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK., Van Hemelrijck M; Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK., O'Brien T; British Association of Urological Surgeons, London, UK.; Urology Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2017 Sep; Vol. 120 (3), pp. 358-364. Date of Electronic Publication: 2017 Apr 24.
DOI: 10.1111/bju.13842
Abstrakt: Objective: To ascertain contemporary overall and differential thirty-day mortality (TDM) rates after all types of nephrectomy in the UK, and to identify potential new risk factors for death.
Patients and Methods: We conducted a retrospective analysis of the 110 deaths that occurred within 30 days of surgery out of the total of 21 380 nephrectomies performed, and calculated the odds ratio (OR) and 95% confidence interval (CI) for TDM based on peri-operative characteristics.
Results: The overall TDM rate was 110/21380 (0.5%). The TDM rates after radical, partial, simple nephrectomy and nephro-ureterectomy were 0.6% (63/11057), 0.1% (4/3931), 0.4% (11/2819) and 0.9% (28/3091), respectively. TDM increased with age, stage, estimated blood loss (EBL), operating time and performance status. EBL of 1-2 L was associated with a greater risk of TDM than EBL of 2-5 L (OR 1.38; 95% CI 1.03-2.24). Conversion from minimally invasive surgery was associated with higher risk than non-conversion (OR 2.53; 95% CI 1.14-4.51. Curative surgery was safer than cytoreductive surgery (OR 0.31; 95% CI 0.18-0.54). There was an association between surgical volume and TDM.
Conclusions: This study provides contemporary insights into the true risks of all types of nephrectomy. The TDM rate after nephrectomy in the UK appears acceptably low at 0.5%. Established risk factors were confirmed and the following novel risk factors were identified: modest EBL (1-2 L) and conversion from minimally invasive surgery.
(© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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