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Socioeconomic Factors, Urological Epidemiology and Practice Patterns
SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS
Socioeconomic Factors, Urological Epidemiology and Practice Patterns Early Clinical and Economic Outcomes of Patients Undergoing Living Donor Nephrectomy in the United States A. L. Friedman, K. Cheung, S. A. Roman and J. A. Sosa Department of Surgery, SUNY Upstate Medical University, Syracuse, New York Arch Surg 2010; 145: 356 –362.
Background: Efforts to maximize kidney transplantation are tempered by concern for the live donor’s safety. Case series and center surveys exist, but national aggregate data are lacking. We sought to determine predictors of early clinical and economic outcomes following living donor nephrectomy. Design: A retrospective cross-sectional analysis using 1999 –2005 discharge data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample was performed. Cases were identified by International Classification of Diseases, Ninth Revision (ICD-9), codes. Clinical and economic outcomes were analyzed with regard to patient and provider characteristics using bivariate and multivariate regression analyses. Setting: Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Patients: Patients undergoing living donor nephrectomy, identified by the ICD-9 codes. Interventions: Clinical and economic outcomes were analyzed with regard to patient and provider characteristics using bivariate and multivariate regression analyses. Main Outcome Measures: Inhospital complications, mortality, mean length of stay (LOS), and mean total hospital costs. Results: A total of 6320 cases were identified with 0% mortality and a complication rate of 18.4%. The mean (SD) LOS was 3.3 (0.3) days, and the mean inpatient cost was $10 708 ($505). Independent predictors of donor complications included older age (odds ratio [OR], 1.01), male sex (OR, 1.19), Charlson Comorbidity Index of at least 1 (OR, 1.49), obesity (OR, 1.76), medium-size hospitals (OR, 1.88), and low-volume hospitals (OR, 1.37). Predictors of longer LOS included older age, female sex, Charlson score of at least 1, lower household income, low-volume and urban hospitals, and low-volume surgeons. Conclusions: Kidney donation is associated with a low mortality rate but an 18% complication rate. Donation by those with advanced age or obesity is associated with higher risks. Informed consent should include discussion of these risks. Editorial Comment: Given that donor nephrectomy as part of living related kidney transplantation is an elective procedure usually performed in healthy patients, every effort should be made to minimize complications. Not surprisingly, this study documents that in addition to the expected clinical risk factors (ie higher comorbidity and obesity), lower volume hospitals have higher complication rates and longer lengths of stay. While I find it odd that medium size hospitals are associated with higher complication rates, the volumeoutcomes relationship makes sense and should not be ignored. Patients need to consider this fact when choosing a hospital for living related renal transplantation. David F. Penson, M.D., M.P.H.
613
Socioeconomic Factors, Urological Epidemiology and Practice Patterns Early Clinical and Economic Outcomes of Patients Undergoing Living Donor Nephrectomy in the United States A. L. Friedman, K. Cheung, S. A. Roman and J. A. Sosa Department of Surgery, SUNY Upstate Medical University, Syracuse, New York Arch Surg 2010; 145: 356 –362.
Background: Efforts to maximize kidney transplantation are tempered by concern for the live donor’s safety. Case series and center surveys exist, but national aggregate data are lacking. We sought to determine predictors of early clinical and economic outcomes following living donor nephrectomy. Design: A retrospective cross-sectional analysis using 1999 –2005 discharge data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample was performed. Cases were identified by International Classification of Diseases, Ninth Revision (ICD-9), codes. Clinical and economic outcomes were analyzed with regard to patient and provider characteristics using bivariate and multivariate regression analyses. Setting: Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Patients: Patients undergoing living donor nephrectomy, identified by the ICD-9 codes. Interventions: Clinical and economic outcomes were analyzed with regard to patient and provider characteristics using bivariate and multivariate regression analyses. Main Outcome Measures: Inhospital complications, mortality, mean length of stay (LOS), and mean total hospital costs. Results: A total of 6320 cases were identified with 0% mortality and a complication rate of 18.4%. The mean (SD) LOS was 3.3 (0.3) days, and the mean inpatient cost was $10 708 ($505). Independent predictors of donor complications included older age (odds ratio [OR], 1.01), male sex (OR, 1.19), Charlson Comorbidity Index of at least 1 (OR, 1.49), obesity (OR, 1.76), medium-size hospitals (OR, 1.88), and low-volume hospitals (OR, 1.37). Predictors of longer LOS included older age, female sex, Charlson score of at least 1, lower household income, low-volume and urban hospitals, and low-volume surgeons. Conclusions: Kidney donation is associated with a low mortality rate but an 18% complication rate. Donation by those with advanced age or obesity is associated with higher risks. Informed consent should include discussion of these risks. Editorial Comment: Given that donor nephrectomy as part of living related kidney transplantation is an elective procedure usually performed in healthy patients, every effort should be made to minimize complications. Not surprisingly, this study documents that in addition to the expected clinical risk factors (ie higher comorbidity and obesity), lower volume hospitals have higher complication rates and longer lengths of stay. While I find it odd that medium size hospitals are associated with higher complication rates, the volumeoutcomes relationship makes sense and should not be ignored. Patients need to consider this fact when choosing a hospital for living related renal transplantation. David F. Penson, M.D., M.P.H.
613