MP45-16 THE IMPACT OF VENOUS THROMBOEMBOLISM PRESENCE AT THE TIME OF NEPHRECTOMY FOR RENAL MASS ON COMPLICATIONS, COSTS, AND SURVIVAL

Abstract

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP45)1 Sep 2021MP45-16 THE IMPACT OF VENOUS THROMBOEMBOLISM PRESENCE AT THE TIME OF NEPHRECTOMY FOR RENAL MASS ON COMPLICATIONS, COSTS, AND SURVIVAL Hiren Patel, Joshua Sterling, Arnav Srivastava, Brian Shinder, Miral Grandhi, David August, Saum Rahimi, Isaac Kim, Saum Ghodoussipour, Thomas Jang, Benjamin Chung, Steven Chang, and Eric Singer Hiren PatelHiren Patel More articles by this author , Joshua SterlingJoshua Sterling More articles by this author , Arnav SrivastavaArnav Srivastava More articles by this author , Brian ShinderBrian Shinder More articles by this author , Miral GrandhiMiral Grandhi More articles by this author , David AugustDavid August More articles by this author , Saum RahimiSaum Rahimi More articles by this author , Isaac KimIsaac Kim More articles by this author , Saum GhodoussipourSaum Ghodoussipour More articles by this author , Thomas JangThomas Jang More articles by this author , Benjamin ChungBenjamin Chung More articles by this author , Steven ChangSteven Chang More articles by this author , and Eric SingerEric Singer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002066.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Venous thromboembolism (VTE), defined as pulmonary embolism (PE) or deep vein thrombosis (DVT), are often seen with advanced malignancy. Recent studies have demonstrated that the presence of bland IVC or renal vein thrombus at the time of renal cell carcinoma (RCC) surgery is associated with worse outcomes. However, the impact of VTE at time of RCC surgery remains to be understood, particularly among patients without an IVC or renal vein thrombus. We evaluated the morbidity and mortality associated with having concurrent VTE at the time of surgical resection of a renal mass. Costs of care were also compared. METHODS: We identified 122,342 patients undergoing elective surgical resection for a renal mass from 2013 to 2017 using the Premier Healthcare database. The cohort was subdivided based on the presence of VTE at the time of admission for radical nephrectomies (RN) and partial nephrectomies (PN). Patients with renal vein thrombus and/or IVC thrombus were excluded from the analysis. The association of VTE with 90-day non-fatal minor (Clavien 1-2) and major (Clavien 3-4) complication rates, mortality, and direct hospital costs (2019 US dollars) was determined with multivariable logistic regression and quantile regression models, respectively, adjusting for patient, hospital, and surgical characteristics. RESULTS: Of the total study population, 83,692 patients underwent RN and 38,650 patients had PN. The predicted probability for a non-fatal minor complication in patients with VTE was significantly higher than patients with no VTE undergoing RN and PN (RN: 34.2% vs 21.1%; PN: 36.9% vs 22.5%; p<0.001). The predicted probability for a non-fatal major complication in patients with VTE was significantly higher than patients with no VTE undergoing RN and PN (RN: 10.6% vs 5.2%; PN: 21.5% vs 5.0%; p<0.001). The predicted probability of mortality in patients with VTE was significantly higher than patients with no VTE undergoing RN and PN (RN: 2.6% vs 1.0%; PN: 1.3% vs 0.3%; p<0.001). The 90-day median costs were greater in patients with VTE compared to no VTE undergoing RN and PN (RN: $24,648 vs $13,951; PN: $19,338 vs $13,694; p<0.001). CONCLUSIONS: VTE at the time of renal surgery for suspected RCC is associated with significantly higher rates of major complications, increased mortality, and higher overall costs. Taken together, these findings may have important implications for the counseling and management of patients with renal masses and VTE. Source of Funding: This work is supported by a grant from the National Cancer Institute (P30CA072720) © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e809-e810 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiren Patel More articles by this author Joshua Sterling More articles by this author Arnav Srivastava More articles by this author Brian Shinder More articles by this author Miral Grandhi More articles by this author David August More articles by this author Saum Rahimi More articles by this author Isaac Kim More articles by this author Saum Ghodoussipour More articles by this author Thomas Jang More articles by this author Benjamin Chung More articles by this author Steven Chang More articles by this author Eric Singer More articles by this author Expand All Advertisement Loading ...