1101 Study of Outcomes of Nephrectomy in Cirrhotic Patients: A National Analysis From a Large Database

Abstract

INTRODUCTION: Nephrectomy is the definitive treatment of the 9th most common cancer- renal cell carcinomas (RCC). Outcomes of various elective surgeries in patients with cirrhosis depends on its stage-compensated cirrhosis (CC) or decompensated (DC). Small-scale studies have reported nephrectomy to be safe in patients with CC. We studied the 30 day readmission rates and its predictors in cirrhotic patients undergoing nephrectomy. We also studied the index and calendar year mortality and their predictors in the cirrhotic patients. METHODS: The National Readmission Database (NRD) was queried using ICD-9 codes to identify 158,443 non-cirrhotic (NC), 942 CC and 212 DC who underwent total or partial nephrectomies, open or laparoscopically from 2010-2014. DC was identified by Baveno IV criteria. Patient demographics, Elixhauser comorbidity index, hospital characteristics, and extent and approach of nephrectomy were collected from the NRD. RESULTS: Thirty-day readmission rates were significantly higher in DC (18.3%) compared to NC patients (7.5%), P < 0.001; it was elevated in CC (11.2%) compared to NC (P = 0.28). Predictors of 30-day readmission were DC (OR: 7.12 versus NC; CI: 4.09-12.38) followed by Elixhauser Comorbidity ≥3 (OR 2.94, Cl: 2.77-3.12), Medicare insurance (OR 1.76 versus private insurance, Cl 1.59, 1.95), and open surgery (OR 1.64, Cl 1.49-1.80). Index and calendar year morality were higher in cirrhotics as compared to NC; CC (OR: 3.80; CI:1.86-7.74) and DC (OR: 7.91; CI: 3.30 -18.92) were the main predictors of morality at index admissions. However, only DC (OR: 3.62; 1.26-10.40) had significant increased risk of calendar year mortality compared to NC. CC (80.9%) and DC (85.8%) were more likely to be treated at metropolitan teaching hospitals as compared to NC (64%). CONCLUSION: Patients with DC undergoing nephrectomy had seven times the odds of 30-day readmission as compared to NC suggesting increased healthcare utilization. DC increased the odds of early readmission and presence of cirrhosis (CC or DC) increased index admission mortality, despite being predominantly managed at metropolitan teaching units where expertise with cirrhotics is greater. Increased attention to medical optimization and surgeon awareness of inherent risks in patients with cirrhosis undergoing nephrectomy is required to improve outcomes.