1791 ASSESSING THE BURDEN OF COMPLICATIONS FOLLOWING RENAL SURGERY IN ELDERLY AND COMORBID PATIENTS

Abstract

You have accessJournal of UrologyKidney Cancer: Localized (V)1 Apr 20131791 ASSESSING THE BURDEN OF COMPLICATIONS FOLLOWING RENAL SURGERY IN ELDERLY AND COMORBID PATIENTS Jeffrey Tomaszewski, Robert Uzzo, Katie Hrebinko, Saum Ghodoussipour, Reza Mehrazin, Anthony Corcoran, Serge Ginzburg, Rosalia Viterbo, David Chen, Richard Greenberg, Alexander Kutikov, and Marc Smaldone Jeffrey TomaszewskiJeffrey Tomaszewski Philadelphia, PA More articles by this author , Robert UzzoRobert Uzzo Philadelphia, PA More articles by this author , Katie HrebinkoKatie Hrebinko Philadelphia, PA More articles by this author , Saum GhodoussipourSaum Ghodoussipour Philadelphia, PA More articles by this author , Reza MehrazinReza Mehrazin Philadelphia, PA More articles by this author , Anthony CorcoranAnthony Corcoran Philadelphia, PA More articles by this author , Serge GinzburgSerge Ginzburg Philadelphia, PA More articles by this author , Rosalia ViterboRosalia Viterbo Philadelphia, PA More articles by this author , David ChenDavid Chen Philadelphia, PA More articles by this author , Richard GreenbergRichard Greenberg Philadelphia, PA More articles by this author , Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author , and Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2841AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With increasing incidental renal tumor detection, rates of renal surgery in the elderly and infirmed are rising. Our aim was to examine the association between high risk patient status (age >75 years and/or Charlson comorbidity [CCI] count >2) and post-operative complications in patients undergoing surgical management for clinically localized renal tumors. METHODS We queried our prospectively maintained institutional database to identify all patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) for clinical stage I-II renal tumors from 2005-2012. Post-operative complications within 90 days were categorized by the Clavien-Dindo classification system. Univariate and multivariate logistic regression models were used to test the association between high risk status and post-operative complications adjusting for patient (risk group, gender, race), tumor (Nephrometry Score [NS], hilar designation, solitary kidney), and operative (year of surgery, nephron sparing and minimally invasive approaches, blood loss, operative time) characteristics. RESULTS 1,092 patients (mean age 59.2±11.9 years, 64.2% male, mean CCI count 1.3±1.6) undergoing PN (71.9%) or RN (28.1%) for clinically localized renal tumors (mean tumor size 4.2±2.9cm, mean NS 7.8±2.0) met inclusion criteria. 255 (23.4%) patients were classified as high risk; of these, 175 (16%) incurred one or more complications (mean 1.6±1.0). High risk patients were more likely to experience a complication compared to those classified as low risk (22.4 versus 14.1%; p=0.002). Comparing high and low risk patients, significant differences in Clavien I-II (20.4 vs. 11.1%; p<0.001) and medical (16.1 vs. 8.1%, p<0.001) complications were observed, while no differences were seen in Clavien III-IV or surgical complications. Further, no differences in complications were observed comparing patients treated with RN and PN, albeit high risk patients were more likely to undergo RN (35.3 vs. 25.9%, p=0.04). Following adjustment, the odds of incurring any complication were 1.9 times higher in high compared to low risk patients (OR 1.9 [CI 1.3-2.8]). CONCLUSIONS In our cohort, patients deemed high risk by age and comorbidity criteria were more likely to incur a complication following renal surgery regardless of surgical type. Improved understanding of surgical risks in the elderly and infirmed will better inform patients deciding between active surveillance and resection of localized renal tumors. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e736 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Tomaszewski Philadelphia, PA More articles by this author Robert Uzzo Philadelphia, PA More articles by this author Katie Hrebinko Philadelphia, PA More articles by this author Saum Ghodoussipour Philadelphia, PA More articles by this author Reza Mehrazin Philadelphia, PA More articles by this author Anthony Corcoran Philadelphia, PA More articles by this author Serge Ginzburg Philadelphia, PA More articles by this author Rosalia Viterbo Philadelphia, PA More articles by this author David Chen Philadelphia, PA More articles by this author Richard Greenberg Philadelphia, PA More articles by this author Alexander Kutikov Philadelphia, PA More articles by this author Marc Smaldone Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...