You have accessJournal of UrologyKidney Cancer: Surgical Therapy VI1 Apr 2015PD49-03 MORTALITY, MORBIDITY AND HEALTHCARE EXPENDITURES AFTER LOCAL TUMOR ABLATION OR PARTIAL NEPHRECTOMY FOR T1A KIDNEY CANCER Alessandro Larcher, Maxine Sun, Malek Meskawi, Katharina Boehm, Roger Valdivieso, Jonas Schiffmann, Zhe Tian, Vincent Trudeau, Nicola Fossati, Nicolò Buffi, Francesco Montorsi, Giorgio Guazzoni, and Pierre Karakiewicz Alessandro LarcherAlessandro Larcher More articles by this author , Maxine SunMaxine Sun More articles by this author , Malek MeskawiMalek Meskawi More articles by this author , Katharina BoehmKatharina Boehm More articles by this author , Roger ValdiviesoRoger Valdivieso More articles by this author , Jonas SchiffmannJonas Schiffmann More articles by this author , Zhe TianZhe Tian More articles by this author , Vincent TrudeauVincent Trudeau More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Nicolò BuffiNicolò Buffi More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , and Pierre KarakiewiczPierre Karakiewicz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2721AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Local tumor ablation (LTA) may yield better perioperative outcomes than partial nephrectomy (PN), however the impact of each treatment on perioperative mortality and health care expenditures is unknown. METHODS A population based assessment of 2471 patients with cT1a kidney cancer treated with either LTA or PN, between 2000 and 2009, in the Surveillance Epidemiology and End Results–Medicare database was performed. After propensity score matching to control for measurable selection bias, multivariable logistic and linear regression models predicting 30-day mortality, overall and specific complication rates, length of stay, readmission rates and health care expenditures (reported in 2014 U.S. $) according to LTA or PN were fitted. RESULTS Median age was 73 (IQR 69-78). Patients treated with LTA were older, more frequently unmarried, sicker, more frequently diagnosed with larger tumors and more frequently diagnosed with non-clear cell histology (all p<0.05). In patients treated with LTA, approach was open, laparoscopic and percutaneous in 7, 54 and 39% of the cohort, respectively. In patients treated with PN, approach was open, laparoscopic and robotic in 71, 24 and 5% of the cohort, respectively. Following a 1:1 ratio propensity score matching, 510 LTA and 510 PN patients remained. The 30-day mortality was <2% after either LTA or PN (OR 2.27 p=0.2). The overall complication rate was 21% after LTA and 40% after PN (OR 0.38 p<0.001). Blood transfusions, infection/sepsis, wound infections, respiratory complications, gastrointestinal complications, acute kidney injury, and accidental puncture or laceration/foreign body left during procedure rates resulted lower after LTA relative to PN (all p<0.05). Similarly, length of stay (-2.6 days p<0.001) and health care expenditures (-5921 U.S. $ p=0.02) resulted lower after LTA relative to PN. Conversely, readmission rate was not significantly different in LTA relative to PN (6 vs. 9.6% p=0.07). CONCLUSIONS Despite similar perioperative mortality, LTA is associated with lower complications rate, shorter length of stay and lower health care expenditure relative to PN. Patients should be instructed that PN is associated with a high risk of perioperative complications and that LTA yields lower probability of various relevant complications, such as blood transfusions and acute renal failure. Moreover, the use of LTA in appropriately selected candidates reduces treatment related morbidity and yields a better allocation of healthcare resources. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e972 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alessandro Larcher More articles by this author Maxine Sun More articles by this author Malek Meskawi More articles by this author Katharina Boehm More articles by this author Roger Valdivieso More articles by this author Jonas Schiffmann More articles by this author Zhe Tian More articles by this author Vincent Trudeau More articles by this author Nicola Fossati More articles by this author Nicolò Buffi More articles by this author Francesco Montorsi More articles by this author Giorgio Guazzoni More articles by this author Pierre Karakiewicz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...