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Kidney Week

Abstract: SA-PO200

AKI and Perioperative Complications Based on Modality of Nephrectomy for Treatment of Kidney Cancer

Session Information

Category: Onconephrology

  • 1700 Onconephrology

Authors

  • Patel, Maulinkumar N., The University of Texas Health Science Center at Houston, Houston, Texas, United States
  • Jaimes, Edgar A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
Background

Historically radical nephrectomy (RN) has been the standard of care for renal masses. However, the use of partial nephrectomy (PN) as a therapeutic modality has become more common. Laparoscopic (LAP) and robotic assisted (RAS) approaches are often used for either RN or PN. In this study we determined the rates of acute kidney injury (AKI) and peri-operative complications based on surgical approach

Methods

We used the National Inpatient Sample NIS 2020-2021 to identify kidney cancer patients who underwent PN or RN . Patients were stratified based on type of surgical approach, (open, LAP or RAS). Bivariate analysis was done using Kruskal Wallis test (for age and length of stay), chi-square test, and Fischer’s exact test. Multivariable logistic and negative binomial regression models were used to assess the outcome rates. Multivariable models were adjusted for age, gender, race, hospital teaching status, and hospital region.

Results

Overall, 4,572 had PN, and 8,104 had RN. Median age was 63 years, 64% were male and 72% were whithe. In PN patients 21% had open, 9% had LAP, and 70% had RAS. In RN patients, 32% had open, 25% had LAP, and 43% had RAS. RN had greater risk of AKI (OR 1.73) as compared to PN. In PN patients, open approach had greater risk of AKI (OR 2.41), cardiac complications (OR 1.40), pulmonary complications (OR 2.34), and increased length of stay [rate ratio (RR) 1.81 ] as compared to RAS. A LAP approach had greater rsik of AKI (OR 1.61) and increased length of stay (RR 1.19,), as compared to RAS. In RN patients, compared to RAS, open approach had greater risk of AKI (OR 1.44), cardiac complications (OR 1.25), intraoperative complications (OR 2.26), pulmonary complications (OR 1.93), vascular complications (OR 3.41), postoperative bleeding (OR 2.6), and increased length of stay (RR 1.72). In RN patients length of stay (RR 1.08) was higher in LAP as compared to RAS.

Conclusion

Our results show a higher risk for AKI among patients undergoing RN as compared to PN. The use of LAP or RAS was associated with a lower risk for AKI and peri-operative complications as compared to open surgery. RAS was linked to a lower risk for AKI and peri-operative complications as compared to LAP. This study underlines the importance of surgical approach on the risk for AKI and perioperative complications in patients undergoing a nephrectomy for cancer.

Funding

  • NIDDK Support