1187 DECREASED MORBIDITY OF MINIMALLY INVASIVE VS OPEN PARTIAL NEPHRECTOMY: A NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) ANALYSIS

Abstract

INTRODUCTION AND OBJECTIVES: Benefits of minimally invasive partial nephrectomy (MIPN) compared to open partial nephrectomy (OPN) include reduced narcotic requirements, shorter hospital stay, and faster convalescence. Some comparative studies suggest that this comes at the price of higher perioperative bleeding risk for MIPN, which may no longer be the case as techniques have evolved. Using a national database, we sought to compare 30 day complication rates between OPN and MIPN. METHODS: Utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data file, patients undergoing OPN or MIPN between January 2007 and December 2010 were identified using Current Procedural Terminology (CPT) codes 50240 and 50543, respectively. NSQIP is an outcomes-based database measuring surgical quality of care. Preoperative and intraoperative variables, as well as 30-day perioperative complications, were collected and analyzed. RESULTS: A total of 1,243 patients were identified who underwent OPN (n 718, 58%) or MIPN (n 525, 42%). The percentage of MIPN increased from 14% in 2007 to 45% in 2010. Pre-operative patient characteristics were similar between the two groups (Table 1). Operative time was significantly longer with MIPN (185.5 vs. 209.7 mins, p 0.001). Hospital stay was shorter following MIPN (5.4 vs. 3.2 days, p 0.001). Postoperatively, the OPN cohort had significantly more superficial wound infections, organ space infections, urinary tract infections, and bleeding events requiring transfusion (Table 2). CONCLUSIONS: The number of partial nephrectomies being performed using minimally invasive techniques (laparoscopic or robotic) is increasing. We acknowledge the limitations of this dataset as we are unable to evaluate nephrometry scores or tumor characteristics. However, in this large national database, MIPN was associated with longer operative times, but shorter hospital stay. OPN was associated with more wound complications, urinary tract infections, and postoperative transfusions. Table 1. Demographics and pre-operative risk factors of patients undergoing OPN and MIPN OPN n 718 MIPN n 525 p-value Male, no. (%) 441 (61) 306 (58) 0.26 Age, yrs (mean) 58.6 59.8 0.101 Body mass index (mean) 30.4 30.3 0.752 Pre-operative creatinine, mg/dL 1.07 1.01 0.141 Smoker, no. (%) 150 (20.1) 99 (19) 0.376 Diabetes, no. (%) 152 (21.2) 89 (17) 0.063 Bleeding disorder, no. (%) 15 (2.1) 8 (1.5) 0.465 Chronic obstructive pulmonary disease, no. (%) 32 (4.5) 17 (3.2) 0.275 Dialysis dependent, no. (%) 8 (1.1) 4 (0.8) 0.53 Peripheral vascular disease, no. (%) 7 (1) 5 (0.9) 0.692 Hypertension, no. (%) 447 (62) 309 (59) 0.225 History of myocardial infarction, no. (%) 2 (0.3) 0 (0) 0.512 History of stroke, no. (%) 22 (3.1) 10 (1.9) 0.204 Operative time, mins (mean) 185.5 209.7 0.001 Length of hospitalization, days (mean) 5.4 3.2 0.001