PD16-01 OBJECTIVE RISK SCORE RELIABLY PREDICTS MORTALITY AFTER RADICAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD16)1 Sep 2021PD16-01 OBJECTIVE RISK SCORE RELIABLY PREDICTS MORTALITY AFTER RADICAL NEPHRECTOMY Kristen Marley, Bradley Houston, Christopher Ledbetter, Robert Wake, A. Lynn Patterson, and Maurizio Buscarini Kristen MarleyKristen Marley More articles by this author , Bradley HoustonBradley Houston More articles by this author , Christopher LedbetterChristopher Ledbetter More articles by this author , Robert WakeRobert Wake More articles by this author , A. Lynn PattersonA. Lynn Patterson More articles by this author , and Maurizio BuscariniMaurizio Buscarini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001998.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical nephrectomy (RN), with or without resection of the ureter, is the treatment of choice for patients with advanced malignancy of the kidney and/or upper urinary tract. We have previously developed and validated a mortality risk score to stratify postoperative outcomes in patients undergoing radical cystectomy. We hypothesized that this 30-day mortality risk score could be applied to patients undergoing RN for malignancy. METHODS: The National Surgical Quality Improvement Program (NSQIP) identified 16,617 patients that underwent RN for upper urinary tract or renal malignancy from 2013-2017. Patients with complete data were included in the analysis. Risk factors for 30-day mortality were identified on multivariable analysis using backward stepwise binary logistic regression. A previously developed and validated mortality risk score (Figure 1A) was calculated for each RN patient. A receiver operating characteristic (ROC) curve quantified the discriminatory ability of the risk calculator. Statistical significance was defined as p values <0.05. RESULTS: Of 9,345 patients included, laparoscopic/robotic technique was applied in 6,112 (65%) patients. The mean age was 64±12 years and most patients were male (n=5950, 64%). Postoperative 30-day mortality was 1.2% (n=116). Older age, elevated creatinine, lower albumin and hematocrit, congestive heart failure, exertional dyspnea, >10% weight loss, disseminated cancer, and open surgery as mortality risk factors. After RN, 30-day mortality increased nearly exponentially with escalating risk category (Figure 1B), p<0.00001. The ROC curve for the risk score is shown in Figure 1C; the area under the curve (AUC) was 0.794 (95% CI, 0.755-0.832; p<0.00001). Relative risk of 30-day mortality increased with escalating risk category: moderate risk=4.8 (2.5-9.1, p<0.00001), high risk=16.8 (9.0-31.5, p<0.00001), and extremely high risk=36.8 (13.4-101.2, p<0.00001). The risk score applied to minimally invasive (AUC, 0.785; 95% CI, 0.722-0.849; p<0.00001) and open RN (0.781; 0.730-0.832; p<0.00001). CONCLUSIONS: A previously established mortality risk score can be employed preoperatively in patients undergoing RN for malignancy to stratify 30-day mortality risk. This 30-day mortality risk score is reliable, accurate, and applicable to both minimally invasive and open RN. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e278-e278 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kristen Marley More articles by this author Bradley Houston More articles by this author Christopher Ledbetter More articles by this author Robert Wake More articles by this author A. Lynn Patterson More articles by this author Maurizio Buscarini More articles by this author Expand All Advertisement Loading ...