Minimally-invasive Nephrectomy Research Articles

MP75-06 NATIONAL OUTCOMES IN POSTOPERATIVE COMPLICATIONS AND READMISSION RATES FOLLOWING OPEN AND MINIMALLY INVASIVE NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V1 Apr 2016MP75-06 NATIONAL OUTCOMES IN POSTOPERATIVE COMPLICATIONS AND READMISSION RATES FOLLOWING OPEN AND MINIMALLY INVASIVE NEPHRECTOMY Ruben M. Pinkhasov, Alexandr Pinkhasov, Michall Abaev, Zuhair Alhussaini, Mark Cogburn, Buddima Ranasinghe, Antonio Montgomery, Ervin Teper, Ciril Godec, and David Silver Ruben M. PinkhasovRuben M. Pinkhasov More articles by this author , Alexandr PinkhasovAlexandr Pinkhasov More articles by this author , Michall AbaevMichall Abaev More articles by this author , Zuhair AlhussainiZuhair Alhussaini More articles by this author , Mark CogburnMark Cogburn More articles by this author , Buddima RanasingheBuddima Ranasinghe More articles by this author , Antonio MontgomeryAntonio Montgomery More articles by this author , Ervin TeperErvin Teper More articles by this author , Ciril GodecCiril Godec More articles by this author , and David SilverDavid Silver More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1724AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Minimally invasive nephrectomy (laparoscopic and robot-assisted) offers lower postoperative morbidity. The purpose of this study is to compare postoperative complications, readmission rates, and predictors of readmission within cohorts of open and minimally invasive nephrectomy (MIN) patients using a national outcomes database. METHODS American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was used to analyze patients who underwent open or MIN in 2012. Perioperative variables and Clavien complications were analyzed using Chi-squared and Student t-test as appropriate. Multinomial logistic regression was used to identify readmission risk factors. RESULTS Of the total (N = 4,548) patients that were included in the analysis, N=1,667 (36.7%) underwent open nephrectomy, and N=2,881 (63.3%) MIN. Open and MIN experienced different readmission rates (7.6% vs. 4.4%, respectively; p<0.001). In addition, open nephrectomy experienced a higher rate of overall complications than MIN (28.9% vs. 10.0%, respectively; p<0.001), and higher rates of reoperation (2.9% vs. 1.9%, respectively; p=0.04). Most common complication for open nephrectomy (N=387; 23.2%) and MIN (N= 174; 6%) was bleeding. Clavien II and III complications were more likely in Open vs. MIN (p<0.001). Overall predictors of readmission included patients with history of diabetes (OR 2.1; p=0.02), hypertension (OR 1.7; p=0.04), and ESRD on hemodialysis (OR 1.2; p <0.001). Risk factors that were not predictive of readmission included age of patient (OR 1.0; p=0.07), operative time (OR 1.0; p=0.88), smoking history (OR 1.0; p=1.0), history of CHF (OR 1.9; p = 1.0), COPD (OR 1.0; p=1.0), or metastatic cancer (OR 0.65; p=0.35). CONCLUSIONS There are significant differences in postoperative complication and readmission rates in open nephrectomy and MIN. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e980 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ruben M. Pinkhasov More articles by this author Alexandr Pinkhasov More articles by this author Michall Abaev More articles by this author Zuhair Alhussaini More articles by this author Mark Cogburn More articles by this author Buddima Ranasinghe More articles by this author Antonio Montgomery More articles by this author Ervin Teper More articles by this author Ciril Godec More articles by this author David Silver More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP70-06 BLOOD TRANSFUSION AND TIMING FOLLOWING OPEN AND MINIMALLY INVASIVE NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Surgical Therapy V1 Apr 2015MP70-06 BLOOD TRANSFUSION AND TIMING FOLLOWING OPEN AND MINIMALLY INVASIVE NEPHRECTOMY Ruben Pinkhasov, Ariel Schulman, Zuhair Alhussaini, Mark Cogburn, Ciril Godec, and David Silver Ruben PinkhasovRuben Pinkhasov More articles by this author , Ariel SchulmanAriel Schulman More articles by this author , Zuhair AlhussainiZuhair Alhussaini More articles by this author , Mark CogburnMark Cogburn More articles by this author , Ciril GodecCiril Godec More articles by this author , and David SilverDavid Silver More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2531AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current minimally invasive nephrectomy (laparoscopic and robot-assisted) may offer lower operative blood loss and reduced need for transfusion. The purpose of this study is to compare contemporary trends in blood transfusion and timing of open and minimally invasive nephrectomy using a national outcomes database. METHODS Using American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database from 2005 to 2012, we analyzed patients who received blood transfusion in the perioperative period undergoing open or minimally invasive nephrectomy (MIN). Outcomes of interest were need and timing of perioperative blood transfusion (PBT) categorized into early (post-operative day ≤ 1) or late (post-operative day ≥ 2). Logistic regression analysis was used to identify variables associated with the need and timing for PBT. RESULTS Of the 12,684 patients that were analyzed, N=2,904 (22.9%) underwent open radical nephrectomy, N=2,387 (18.8%) open partial nephrectomy, N=4,428 (34.9%) laparoscopic radical nephrectomy, and N=2,965 (23.4%) laparoscopic partial nephrectomy. Overall, PBT rate was 10.1% (N=1,283). Open radical nephrectomy was 4.8 (95% CI: 4.1-5.5) times more likely to have bleeding complication that required transfusion than laparoscopic radical nephrectomy. Whereas open partial nephrectomy was 2.8 (95% CI: 2.3-3.5) times more likely to have bleeding complication requiring transfusion than laparoscopic partial nephrectomy. Open nephrectomy was 1.5 (95% CI: 1.1-2.1) times more likely to be transfused early (POD ≤ 1), compared to MIN. Still 14.3% of open nephrectomy and 20.2% of MIN patients required late (POD ≥ 2) transfusion. On logistic regression analysis significant predictors of transfusion included preoperative dyspnea (OR: 1.7; p<0.001), starting hematocrit <42 (OR: 1.4; p<0.001), open nephrectomy (OR 1.3; p <0.001), operative time (OR 0.9; p<0.001) and year of surgery (OR 0.9; p=0.028). Predictors that were not associated with transfusion included history of bleeding disorder (OR 3.6; p = 0.252), and resident involvement (OR 1.1; p=0.289). CONCLUSIONS Overall, perioperative blood transfusion rate is low. Radical or partial open nephrectomy is more likely to require transfusion and to be transfused early than MIN. Preoperative dyspnea, starting hematocrit <42, open nephrectomy, operative time, and year of surgery are significant predictors requiring transfusion. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e877 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ruben Pinkhasov More articles by this author Ariel Schulman More articles by this author Zuhair Alhussaini More articles by this author Mark Cogburn More articles by this author Ciril Godec More articles by this author David Silver More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Optimized Outcome and High Individual Acceptance after Living Donor Transplantation with Minimally Invasive Nephrectomy in Comparison to Postmortal Transplantation: Analysis of Long Term Results

Living kidney donation with minimally invasive nephrectomy (MIN) was established as adequate procedures regarding transplant function and perioperative results. However, the specific beneficial effects of MIN for donor and recipient were not investigated so far. Aim of study was to analyze transplant function and long-term results in comparison to postmortal transplantation (TX), as well as individual acceptance of donors and recipients after lapaproscopic and open nephectomy for living donation. Between 1998 and 2011, 175 living donors and recipients were investigated regarding kidney function and transplant survival and compared with 710 postmortal TX patients without primary transplant dysfunction. Incidence of newly diagnosed hypertension and proteinuria were assessed. Additionally, standardized analysis of quality of life and patient's satisfaction were analyzed. Livinig donor recipients had a 10 year transplant survival of 94% compared to 72% after postmortal TX. 118 patients had laparoscopic nephrectomy, 57 patients had open nephrectomy. There were no significant differences regarding transplant function and survival and no differences in kidney function, proteinuria or hypertonia in the donors (Creatinine,15/1,12 mg/dl after 3 years). Hospitalization was substantially shortened after laparoscopic nephrectomy (9,8 vs. 13,0 days, p=0.01). The incidence of incisional hernia was higher after open nephrectomy (9,8 vs. 13,0 Tage, p=0.01). In the laparoscopic group, higher satisfaction and acceptance was observed (p=0.05). Living donor kidney transplantation is associated with excellent long-term results of transplant function and survival. Minimally invasive nephrectomy is superior to open technique due to decreased hospitalization, incidence of incisional hernia and higher acceptance and should be preferred after careful assessments of individual risks.