Renal surgery for kidney cancer in Germany 2005–2006: length of stay, risk of postoperative complications and in-hospital death

Abstract

BackgroundRepresentative statistics of surgical care among patients with kidney cancer are scant. With the introduction of the diagnosis related group system in Germany, it is now possible to provide nationwide statistics on surgical care. We studied in-hospital mortality risk in relation to comorbidity and complications, length of hospital stay in relation to surgical approach and comorbidity, and risk of complications in relation to surgical approach among kidney cancer patients undergoing nephrectomy.MethodsWe analyzed the nationwide hospitalization file of the years 2005 and 2006 including 23,753 hospitalizations with a diagnosis of renal cancer and partial or complete nephrectomy and classified comorbidity (Charlson comorbidity index) and complications. Length of stay, risk of in-hospital complications and in-hospital death were analyzed by linear regression and log-linear regression (relative risks (RR) and 95% confidence intervals (95% CI)).ResultsThe overall in-hospital mortality was 1.4%. Per one unit increase of the Charlson comorbidity index, the adjusted risk of in-hospital mortality increased by 53% (95% CI 47-59%). The risks of bleeding or acute posthaemorrhagic anemia, respiratory, urological and gastrointestinal complications and infections ranged between 1.1% and 2.7% with the exception of bleeding or acute posthaemorrhagic anemia with 18.4%. Complications were associated with an increased adjusted in-hospital mortality risk. Highest adjusted mortality risk ratios were observed for gastrointestinal (RR = 3.61, 95% CI 2.32-5.63) and urological complications (RR = 3.62, 95% CI 2.62-5.00). The risk of haemorrhage or acute posthaemorrhagic anemia was lower for total laparoscopic nephrectomies than total open nephrectomies. The adjusted risk of gastrointestinal complications was lower for partial open compared to total open nephrectomy (adjusted RR = 0.66, 95% CI 0.45-0.97). Total laparoscopic nephrectomy was associated with shorter length of stay (−3.3 days; 95% CI 2.9-3.7 days) compared to total open nephrectomy. The estimated age-adjusted increase of length of stay per one unit increase of the Charlson comorbidity index was 1.3 days (95% CI 1.2-1.4 days).ConclusionsIn this representative population-based analysis, we found that the surgical approach is associated with the risk of complications and length of hospital stay. Furthermore, in the era of ageing populations, renal cancer patients with comorbidities should be counseled about their increased in-hospital mortality risk.

Nephrectomy improves the survival of metastatic renal cell cancer patients with moderate to good performance status—results from a Finnish nation-wide population-based study from 2005 to 2010

“…A considerable rate of severe complications occurred in the postoperative period. The complication rates are comparable to previous reports (i.e., Stang et al reported an intrahospital mortality of 1.4% patients undergoing nephrectomy for the treatment of renal cancer in Germany in a 2-year period [ 30 ]). In a large contemporary cohort of 3644 CN-treated patients with mRCC from the USA, Palumbo et al showed an overall complication risk of 39.7–55.3%, stratified according to age groups.…”

Postoperative 30-day Mortality Rates for Kidney Cancer Are Dependent on Hospital Surgical Volume: Results from a Norwegian Population-based Study

“…Complications rates after PN and RN are reported to be 16-26% [210][211][212]. Major complications (defined as Clavien-Dindo ≥3) are reported to be 5.4% for PN and 3.1% for RN [203].…”

Real-life use of diagnostic biopsies before treatment of kidney cancer: results from a Norwegian population-based study

“…To improve outcomes, it is important to avoid the "failure to rescue". Therefore, a department must postoperatively prevent complications, and organize the postoperative surveillance so that complications are caught early and treated by a competent specialist as soon as possible [203,210,212,220].…”

“…Causes of death differ, but cardiac disease, infectious diseases, embolisms and bleeding are typically related[212,217]. Gastrointestinal and urologic complications were associated with IHM[210]. As described by Cloutier, tumor stage is determinant of TDM.…”

“…It was reduced from 5% in the 1970s to an in-hospital mortality (IHM) of 0.7-1.4%[64,206,210] and 30-day mortality (TDM) of 0.9-2.8%[216,217] in contemporary materials. Modern figures for mortality after cytoreductive nephrectomy are still higher (3.2-4.2%) [216, 217].IHM and TDM increase with an increasing comorbidity and complications[203,210,211]. Causes of death differ, but cardiac disease, infectious diseases, embolisms and bleeding are typically related[212,217].…”