Patel HV, Sterling JA, Srivastava A, Ghodoussipour SB, Jang TL, Grandhi MS, August DA, Rahimi SA, Chung BI, Chang SL, Singer EA. The Impact of Venous Thromboembolism on Mortality and Morbidity During Nephrectomy for Renal Mass.
Urology 2022;
168:122-128. [PMID:
35691439 DOI:
10.1016/j.urology.2022.05.033]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/21/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES
To determine the morbidity, mortality, and costs associated with having concurrent venous thromboembolism (VTE) at the time of surgical resection of a renal mass.
PATIENTS AND METHODS
We identified 108,430 patients undergoing elective partial or radical nephrectomy for a renal mass from 2013 to 2017 using the Premier Healthcare database. The association of VTE with 90-day complication rates, mortality, ICU admission, readmission, and direct hospital costs (2019 US dollars) was determined with multivariable logistic regression and quantile regression models, respectively.
RESULTS
Of the 108,430 patients who underwent elective partial or radical nephrectomy, 1.2% (n=1,301) of patients were diagnosed with a preoperative VTE. Patients with preoperative VTE have higher rates of minor (OR 1.47, 95% CI 1.34-1.62, p<0.0001) and major complications (OR 2.53, 95% CI 2.23-2.86, p<0.0001), mortality (OR 2.03, 95% CI 1.6-2.57, p<0.0001), and readmissions (OR 1.73, 95% CI 1.57-1.90, p<0.0001) compared to patients without preoperative VTE at the time of nephrectomy. Notably, the predicted probability for a major complication was significantly higher among patients with preoperative VTE who underwent either partial or radical nephrectomy, irrespective of the surgical approach utilized. Furthermore, rates of all types of complications except endocrine and soft tissue were significantly increased in patients undergoing nephrectomy with preoperative VTE compared to those without VTE.
CONCLUSIONS
VTE at the time of nephrectomy is associated with significantly higher rates of major complications, increased mortality, and higher overall costs. Taken together, these findings have important implications for the counseling and management of renal masses in presence of VTE.
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