- Email: [email protected]
1187 DECREASED MORBIDITY OF MINIMALLY INVASIVE VS OPEN PARTIAL NEPHRECTOMY: A NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) ANALYSIS
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
THE JOURNAL OF UROLOGY姞
e485
Table 1. Demographics and pre-operative risk factors of patients undergoing OPN and MIPN OPN MIPN n⫽718 n⫽525 p-value Male, no. (%) 441 (61) 306 (58) 0.26 Age, yrs (mean)
58.6
59.8
0.101
Body mass index (mean)
30.4
30.3
0.752
Pre-operative creatinine, mg/dL
1.07
1.01
0.141
Smoker, no. (%)
150 (20.1)
99 (19)
0.376
Diabetes, no. (%)
152 (21.2)
89 (17)
0.063
Bleeding disorder, no. (%)
15 (2.1)
8 (1.5)
0.465
Chronic obstructive pulmonary disease, no. (%)
32 (4.5)
17 (3.2)
0.275
Dialysis dependent, no. (%)
8 (1.1)
4 (0.8)
0.53
7 (1)
5 (0.9)
0.692
447 (62)
309 (59)
0.225 0.512
Peripheral vascular disease, no. (%) Hypertension, no. (%)
Source of Funding: Supported by grants number 5U10 CA11488-24 through 5U10 CA011488-40 from the National Cancer Institute (Bethesda, MD, USA) and by Fonds Cancer (FOCA) from Belgium.
History of myocardial infarction, no. (%)
2 (0.3)
0 (0)
History of stroke, no. (%)
22 (3.1)
10 (1.9)
0.204
185.5
209.7
⬍0.001
5.4
3.2
⬍0.001
Operative time, mins (mean) Length of hospitalization, days (mean)
1187 DECREASED MORBIDITY OF MINIMALLY INVASIVE VS OPEN PARTIAL NEPHRECTOMY: A NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) ANALYSIS
Table 2. 30-day outcomes of patients undergoing OPN and MIPN Complication, no. (%) OPN MIPN p-value Superficial wound infection 10 (1.4) 1 (0.2) 0.03 Deep wound infection
4 (0.6)
1 (0.2)
0.404
Organ space infection
12 (1.7)
2 (0.4)
0.033
Wound dehiscence
3 (0.4)
3 (0.6)
0.7
Casey Kowalik*, Andrea Sorcini, Alireza Moinzadeh, David Canes, Burlington, MA
Urinary tract infection
22 (3.1)
7 (1.3)
0.046
Deep vein thrombosis
3 (0.4)
7 (1.3)
0.106
INTRODUCTION AND OBJECTIVES: Benefits of minimally invasive partial nephrectomy (MIPN) compared to open partial nephrectomy (OPN) include reduced narcotic requirements, shorter hospital stay, and faster convalescence. Some comparative studies suggest that this comes at the price of higher perioperative bleeding risk for MIPN, which may no longer be the case as techniques have evolved. Using a national database, we sought to compare 30 day complication rates between OPN and MIPN. METHODS: Utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data file, patients undergoing OPN or MIPN between January 2007 and December 2010 were identified using Current Procedural Terminology (CPT) codes 50240 and 50543, respectively. NSQIP is an outcomes-based database measuring surgical quality of care. Preoperative and intraoperative variables, as well as 30-day perioperative complications, were collected and analyzed. RESULTS: A total of 1,243 patients were identified who underwent OPN (n⫽718, 58%) or MIPN (n⫽525, 42%). The percentage of MIPN increased from 14% in 2007 to 45% in 2010. Pre-operative patient characteristics were similar between the two groups (Table 1). Operative time was significantly longer with MIPN (185.5 vs. 209.7 mins, p⬍0.001). Hospital stay was shorter following MIPN (5.4 vs. 3.2 days, p⬍0.001). Postoperatively, the OPN cohort had significantly more superficial wound infections, organ space infections, urinary tract infections, and bleeding events requiring transfusion (Table 2). CONCLUSIONS: The number of partial nephrectomies being performed using minimally invasive techniques (laparoscopic or robotic) is increasing. We acknowledge the limitations of this dataset as we are unable to evaluate nephrometry scores or tumor characteristics. However, in this large national database, MIPN was associated with longer operative times, but shorter hospital stay. OPN was associated with more wound complications, urinary tract infections, and postoperative transfusions.
Bleeding requiring transfusion
41 (5.7)
12 (2.2)
0.003
Pneumonia
6 (0.8)
5 (1)
1
Pulmonary embolism
6 (0.8)
5 (1)
1
Re-intubation
7 (0.9)
2 (0.4)
0.317
Acute renal failure
13 (1.8)
3 (0.6)
0.056
Stroke
3 (0.4)
0 (0)
0.267
Cardiac arrest
5 (0.7)
2 (0.28)
0.706
Sepsis/septic shock
21 (2.9)
7 (0.96)
0.062
Return to operating room
22 (3.1)
12 (1.65)
0.406
Source of Funding: None. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
1188 INCIDENCE AND RISK FACTORS OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH T1A RENAL CELL CARCINOMA BEFORE AND AFTER RADICAL OR PARTIAL NEPHRECTOMY Sung Han KIM*, Seoul, Korea, Republic of; Sang Eun Lee, Incheon, Korea, Republic of; YongHyun PARK, Seoul, Korea, Republic of; SungKyu Hong, Chang Wook Jeong, Incheon, Korea, Republic of; Yong-June KIM, Cheongju, Korea, Republic of; Seok Ho Kang, Sung-Hoo Hong, Seoul, Korea, Republic of; Seok-Soo Byun, Incheon, Korea, Republic of INTRODUCTION AND OBJECTIVES: As more incidental, small renal masses are increasingly detected and the negative relationship between long-term Chronic kidney disease(CKD) and morbidity/mortality is uncovered, the preservation of kidney function and its related aggravating factors will continue to be emphasized. Our study will investigate the incidence rate of CKD in patients with T1a renal cell carcinoma before and after the partial or radical nephrectomy and assess risk factors for CKD.
THE JOURNAL OF UROLOGY姞
e485
Table 1. Demographics and pre-operative risk factors of patients undergoing OPN and MIPN OPN MIPN n⫽718 n⫽525 p-value Male, no. (%) 441 (61) 306 (58) 0.26 Age, yrs (mean)
58.6
59.8
0.101
Body mass index (mean)
30.4
30.3
0.752
Pre-operative creatinine, mg/dL
1.07
1.01
0.141
Smoker, no. (%)
150 (20.1)
99 (19)
0.376
Diabetes, no. (%)
152 (21.2)
89 (17)
0.063
Bleeding disorder, no. (%)
15 (2.1)
8 (1.5)
0.465
Chronic obstructive pulmonary disease, no. (%)
32 (4.5)
17 (3.2)
0.275
Dialysis dependent, no. (%)
8 (1.1)
4 (0.8)
0.53
7 (1)
5 (0.9)
0.692
447 (62)
309 (59)
0.225 0.512
Peripheral vascular disease, no. (%) Hypertension, no. (%)
Source of Funding: Supported by grants number 5U10 CA11488-24 through 5U10 CA011488-40 from the National Cancer Institute (Bethesda, MD, USA) and by Fonds Cancer (FOCA) from Belgium.
History of myocardial infarction, no. (%)
2 (0.3)
0 (0)
History of stroke, no. (%)
22 (3.1)
10 (1.9)
0.204
185.5
209.7
⬍0.001
5.4
3.2
⬍0.001
Operative time, mins (mean) Length of hospitalization, days (mean)
1187 DECREASED MORBIDITY OF MINIMALLY INVASIVE VS OPEN PARTIAL NEPHRECTOMY: A NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) ANALYSIS
Table 2. 30-day outcomes of patients undergoing OPN and MIPN Complication, no. (%) OPN MIPN p-value Superficial wound infection 10 (1.4) 1 (0.2) 0.03 Deep wound infection
4 (0.6)
1 (0.2)
0.404
Organ space infection
12 (1.7)
2 (0.4)
0.033
Wound dehiscence
3 (0.4)
3 (0.6)
0.7
Casey Kowalik*, Andrea Sorcini, Alireza Moinzadeh, David Canes, Burlington, MA
Urinary tract infection
22 (3.1)
7 (1.3)
0.046
Deep vein thrombosis
3 (0.4)
7 (1.3)
0.106
INTRODUCTION AND OBJECTIVES: Benefits of minimally invasive partial nephrectomy (MIPN) compared to open partial nephrectomy (OPN) include reduced narcotic requirements, shorter hospital stay, and faster convalescence. Some comparative studies suggest that this comes at the price of higher perioperative bleeding risk for MIPN, which may no longer be the case as techniques have evolved. Using a national database, we sought to compare 30 day complication rates between OPN and MIPN. METHODS: Utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data file, patients undergoing OPN or MIPN between January 2007 and December 2010 were identified using Current Procedural Terminology (CPT) codes 50240 and 50543, respectively. NSQIP is an outcomes-based database measuring surgical quality of care. Preoperative and intraoperative variables, as well as 30-day perioperative complications, were collected and analyzed. RESULTS: A total of 1,243 patients were identified who underwent OPN (n⫽718, 58%) or MIPN (n⫽525, 42%). The percentage of MIPN increased from 14% in 2007 to 45% in 2010. Pre-operative patient characteristics were similar between the two groups (Table 1). Operative time was significantly longer with MIPN (185.5 vs. 209.7 mins, p⬍0.001). Hospital stay was shorter following MIPN (5.4 vs. 3.2 days, p⬍0.001). Postoperatively, the OPN cohort had significantly more superficial wound infections, organ space infections, urinary tract infections, and bleeding events requiring transfusion (Table 2). CONCLUSIONS: The number of partial nephrectomies being performed using minimally invasive techniques (laparoscopic or robotic) is increasing. We acknowledge the limitations of this dataset as we are unable to evaluate nephrometry scores or tumor characteristics. However, in this large national database, MIPN was associated with longer operative times, but shorter hospital stay. OPN was associated with more wound complications, urinary tract infections, and postoperative transfusions.
Bleeding requiring transfusion
41 (5.7)
12 (2.2)
0.003
Pneumonia
6 (0.8)
5 (1)
1
Pulmonary embolism
6 (0.8)
5 (1)
1
Re-intubation
7 (0.9)
2 (0.4)
0.317
Acute renal failure
13 (1.8)
3 (0.6)
0.056
Stroke
3 (0.4)
0 (0)
0.267
Cardiac arrest
5 (0.7)
2 (0.28)
0.706
Sepsis/septic shock
21 (2.9)
7 (0.96)
0.062
Return to operating room
22 (3.1)
12 (1.65)
0.406
Source of Funding: None. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
1188 INCIDENCE AND RISK FACTORS OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH T1A RENAL CELL CARCINOMA BEFORE AND AFTER RADICAL OR PARTIAL NEPHRECTOMY Sung Han KIM*, Seoul, Korea, Republic of; Sang Eun Lee, Incheon, Korea, Republic of; YongHyun PARK, Seoul, Korea, Republic of; SungKyu Hong, Chang Wook Jeong, Incheon, Korea, Republic of; Yong-June KIM, Cheongju, Korea, Republic of; Seok Ho Kang, Sung-Hoo Hong, Seoul, Korea, Republic of; Seok-Soo Byun, Incheon, Korea, Republic of INTRODUCTION AND OBJECTIVES: As more incidental, small renal masses are increasingly detected and the negative relationship between long-term Chronic kidney disease(CKD) and morbidity/mortality is uncovered, the preservation of kidney function and its related aggravating factors will continue to be emphasized. Our study will investigate the incidence rate of CKD in patients with T1a renal cell carcinoma before and after the partial or radical nephrectomy and assess risk factors for CKD.