Ravin Bastiampillai1, Luke T Lavallée2, Sonya Cnossen3, Kelsey Witiuk3, Ranjeeta Mallick3, Dean Fergusson3, David Schramm4, Christopher Morash1, Ilias Cagiannos1, Rodney H Breau2. 1. Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; 2. Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada; 3. Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada; 4. Division of Otolaryngology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Abstract
INTRODUCTION: Laparoscopic radical nephrectomy (LRN) and laparoscopic nephroureterectomy (LNU) are similar procedures and some surgeons may believe the perioperative risks are the same. The purpose of this study is to characterize and compare complications following LRN and LNU. METHODS: A historical cohort of patients who received either LRN or LNU between 2006 and 2012 was reviewed from the National Surgical Quality Improvement Program (NSQIP) database. Patient characteristics, surgical characteristics, and perioperative outcomes up to 30 days postoperatively were abstracted. Unadjusted and adjusted associations between procedure (LRN or LNU) and any adverse event were determined. RESULTS: During the study period, 4904 patients met study inclusion criteria; 4159 (84.8%) received a LRN while 745 (15.2%) received a LNU. Overall, 651 (13.3%) patients experienced at least one postoperative complication. LNU was associated with more complications than LRN (21% and 12%, respectively, p value <0.01). The most common complications were: bleeding requiring blood transfusion (9.0% LNU vs. 6.0% LRN), urinary tract infection (4.6% LNU vs. 1.5% LRN), wound infection (1.3% LNU vs. 1.8% LRN), and unplanned intubation (2.3% LNU vs. 0.9% LRN). After adjusting for potential confounders, LNU was associated with higher risk of any complication compared to LRN (relative risk [RR] 1.41, 95% confidence interval [CI] 1.16-1.72). Other variables independently associated with an increased risk of complications included: increasing patient age (RR 1.01, 95% CI 1.01-1.02), American Society of Anesthesiologists (ASA) classification ≥3 (RR 1.34, 95% CI 1.10-1.63), higher preoperative creatinine (RR 1.11, 95% CI 1.06-1.17), >4 units of blood transfused within 72 hours before surgery (RR 1.93, 95% CI 1.29-2.86), and operative time >6 hours (RR 2.17, 95% CI 1.71-2.75). CONCLUSIONS: Postoperative complications within 30 days of surgery are common after LNU and LRN. Despite having technical similarities, LNU carries a significantly higher risk of developing short-term complications compared to LRN. This information should be considered when counseling patients prior to surgery. Notable limitations of this study included the lack of information on tumour stage and management of the distal ureter.
INTRODUCTION: Laparoscopic radical nephrectomy (LRN) and laparoscopic nephroureterectomy (LNU) are similar procedures and some surgeons may believe the perioperative risks are the same. The purpose of this study is to characterize and compare complications following LRN and LNU. METHODS: A historical cohort of patients who received either LRN or LNU between 2006 and 2012 was reviewed from the National Surgical Quality Improvement Program (NSQIP) database. Patient characteristics, surgical characteristics, and perioperative outcomes up to 30 days postoperatively were abstracted. Unadjusted and adjusted associations between procedure (LRN or LNU) and any adverse event were determined. RESULTS: During the study period, 4904 patients met study inclusion criteria; 4159 (84.8%) received a LRN while 745 (15.2%) received a LNU. Overall, 651 (13.3%) patients experienced at least one postoperative complication. LNU was associated with more complications than LRN (21% and 12%, respectively, p value <0.01). The most common complications were: bleeding requiring blood transfusion (9.0% LNU vs. 6.0% LRN), urinary tract infection (4.6% LNU vs. 1.5% LRN), wound infection (1.3% LNU vs. 1.8% LRN), and unplanned intubation (2.3% LNU vs. 0.9% LRN). After adjusting for potential confounders, LNU was associated with higher risk of any complication compared to LRN (relative risk [RR] 1.41, 95% confidence interval [CI] 1.16-1.72). Other variables independently associated with an increased risk of complications included: increasing patient age (RR 1.01, 95% CI 1.01-1.02), American Society of Anesthesiologists (ASA) classification ≥3 (RR 1.34, 95% CI 1.10-1.63), higher preoperative creatinine (RR 1.11, 95% CI 1.06-1.17), >4 units of blood transfused within 72 hours before surgery (RR 1.93, 95% CI 1.29-2.86), and operative time >6 hours (RR 2.17, 95% CI 1.71-2.75). CONCLUSIONS: Postoperative complications within 30 days of surgery are common after LNU and LRN. Despite having technical similarities, LNU carries a significantly higher risk of developing short-term complications compared to LRN. This information should be considered when counseling patients prior to surgery. Notable limitations of this study included the lack of information on tumour stage and management of the distal ureter.
Authors: Giovanni Lughezzani; Maximilian Burger; Vitaly Margulis; Surena F Matin; Giacomo Novara; Morgan Roupret; Shahrokh F Shariat; Christopher G Wood; Richard Zigeuner Journal: Eur Urol Date: 2012-02-23 Impact factor: 20.096
Authors: Sompol Permpongkosol; Richard E Link; Li-Ming Su; Frederico R Romero; Herman S Bagga; Christian P Pavlovich; Thomas W Jarrett; Louis R Kavoussi Journal: J Urol Date: 2007-02 Impact factor: 7.450
Authors: Fernando J Kim; Koon H Rha; Fernando Hernandez; Thomas W Jarrett; Peter A Pinto; Louis R Kavoussi Journal: J Urol Date: 2003-08 Impact factor: 7.450
Authors: J Kellogg Parsons; Ioannis Varkarakis; Koon H Rha; Thomas W Jarrett; Peter A Pinto; Louis R Kavoussi Journal: Urology Date: 2004-01 Impact factor: 2.649
Authors: Bryce A Basques; Ryan P McLynn; Michael P Fice; Andre M Samuel; Adam M Lukasiewicz; Daniel D Bohl; Junyoung Ahn; Kern Singh; Jonathan N Grauer Journal: Clin Orthop Relat Res Date: 2017-12 Impact factor: 4.176