MP84-07 RISK STRATIFICATION FOR ADVERSE OUTCOMES FOLLOWING RENAL MASS EXCISION

Abstract

You have accessJournal of UrologyKidney Cancer: Surgical Therapy VII1 Apr 2015MP84-07 RISK STRATIFICATION FOR ADVERSE OUTCOMES FOLLOWING RENAL MASS EXCISION Timothy Ito, Philip Abbosh, Nikhil Waingankar, Mohammed Haseebuddin, Serge Ginzburg, Daniel Canter, David Chen, Richard Greenberg, Rosalia Viterbo, Alexander Kutikov, Marc Smaldone, and Robert Uzzo Timothy ItoTimothy Ito More articles by this author , Philip AbboshPhilip Abbosh More articles by this author , Nikhil WaingankarNikhil Waingankar More articles by this author , Mohammed HaseebuddinMohammed Haseebuddin More articles by this author , Serge GinzburgSerge Ginzburg More articles by this author , Daniel CanterDaniel Canter More articles by this author , David ChenDavid Chen More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , and Robert UzzoRobert Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1974AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Tailoring perioperative management to minimize postoperative complications depends on reliable prognostication of those patients most at risk. The Surgical Apgar Score (SAS) is an objective measure of the operative course based on EBL, lowest heart rate and MAP, validated to predict major complications following general surgery. We aimed to assess the ability of the SAS, Nephrometry Score (NS) and Charlson Comorbidity Index (CCI) to predict for postoperative morbidity and mortality following extirpative renal surgery. METHODS Data for 886 patients undergoing renal mass excision via partial/radical nephrectomy from 2010-2013 was extracted from a prospectively collected database at a single institution. Major postoperative complications examined included cardiopulmonary/infectious complications, significant leak/hemorrhage, and any readmission/re-operation within 30 days of surgery, as well as 90-day mortality. Significant SAS, CCI, and NS cutoffs were identified using the recursive partitioning method. Univariate analysis was done via Chi-square or Wilcoxon tests. Multivariable analysis (MVA) was done via logistic regression or the generalized linear method. RESULTS 13.3% of patients experienced major postoperative complications. Clavien grade I, II, III, IV and V complications were experienced by 1.7%, 2.9%, 5.8%, 1.9% and 0.9%. The 90-day mortality rate was 1.4%. SAS was lower (mean 7.3 vs 7.8, p=0.002) while NS (8.8 vs 8.0, p=0.0001) and CCI (1.7 vs 1.2, p=0.003) were higher in patients experiencing major postoperative complications. Patients experiencing major complications also were older (mean 62 vs 59yo, p=0.01) and more likely to have undergone open surgery (55% vs 32%, p<0.0001). SAS was also lower in patients dying within 90 days of surgery (6.3 vs 7.7, p=0.03). On MVA controlling for age and surgical type, a CCI score ≥ 1 (OR 1.61, 95% CI 1.04-2.49; p=0.03) and a NS ≥ 8 (OR 1.80, 95% CI 1.11-2.91; p=0.02) remained significant predictors of major postoperative complications. An SAS ≤ 4 was the strongest predictor of 90-day mortality (OR 15.4, 95% CI 3.61-66.7; p=0.0002). SAS was also an independent predictor of postoperative length of stay with each 3 point decrease in SAS corresponding to 1 extra day in the hospital (p=0.0002). CONCLUSIONS SAS, NS and CCI are simply collected metrics that can identify patients at a higher risk for adverse events following renal mass excision. A prospective trial to help further delineate optimal utilization of these tools in an adjusted perioperative management approach with patients undergoing complex renal mass excision is warranted. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1060 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy Ito More articles by this author Philip Abbosh More articles by this author Nikhil Waingankar More articles by this author Mohammed Haseebuddin More articles by this author Serge Ginzburg More articles by this author Daniel Canter More articles by this author David Chen More articles by this author Richard Greenberg More articles by this author Rosalia Viterbo More articles by this author Alexander Kutikov More articles by this author Marc Smaldone More articles by this author Robert Uzzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...