Reevaluating Warm Ischemia Time as a Predictor of Renal Function Outcomes After Robotic Partial Nephrectomy
| Autor: | Ketan K. Badani, Daniel C. Rosen, Akshay Bhandari, Muthumeena Kannappan, Kyrollis Attalla, James Porter, Daniel Eun, Alp Tuna Beksac, Ronney Abaza, Ashok K. Hemal, David J. Paulucci |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Multivariate analysis Adolescent Urology medicine.medical_treatment Blood Loss Surgical 030232 urology & nephrology Renal function Kidney Nephrectomy Young Adult 03 medical and health sciences Sex Factors 0302 clinical medicine Robotic Surgical Procedures Humans Medicine Renal Insufficiency Warm Ischemia Young adult Aged Retrospective Studies Aged 80 and over Warm Ischemia Time business.industry Acute kidney injury Retrospective cohort study Perioperative Acute Kidney Injury Length of Stay Middle Aged medicine.disease Kidney Neoplasms 030220 oncology & carcinogenesis Multivariate Analysis Female business Follow-Up Studies Glomerular Filtration Rate |
| Zdroj: | Urology. 120:156-161 |
| ISSN: | 0090-4295 |
| DOI: | 10.1016/j.urology.2018.06.019 |
| Popis: | To explore whether variation of warm ischemia time (WIT) is associated with functional and perioperative outcomes following robotic partial nephrectomy (RPN).Six hundred sixty eight patients, each with 2 kidneys, undergoing RPNs for a cT1 tumor were identified from a U.S. multi-institutional database. The associations between WIT, normal excisional volume loss (EVL), and surgical and renal function outcomes, including acute kidney injury at discharge and percent change in eGFR at up to 24 months post-RPN, were evaluated using Spearman's rank correlation test as well as multivariable models controlling for tumor, surgeon, and patient characteristics.WIT was weakly correlated with EVL (r = 0.32, P.001), blood loss (r = 0.34, P.001), and length of stay (r = 0.35, P.001). WIT was found to be significantly associated with acute kidney injury at discharge (odds ratio = 6.23; confidence interval 1.52, 30.39). Extended WIT was not found to be significantly associated with renal function decline at 1 year post RPN (P.05).Extended WIT is associated with worse perioperative outcomes. While controlling for tumor size and EVL, effects on short-term renal function were still seen after as short as 20 minutes. Efforts to limit warm ischemia time should continue to be implemented during RPN to maximize postoperative renal function. |
| Databáze: | OpenAIRE |
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