Perioperative Morbidity of Open Versus Minimally Invasive Partial Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program

Overview

Journal J Endourol

Publisher Mary Ann Liebert

Specialties Gastroenterology
Urology

Date 2017 Nov 11

PMID 29121786

Citations 9

Authors

Jorge Pereira

Joseph Renzulli 2nd

Gyan Pareek

Daniel Moreira

Ruiting Guo

Zheng Zhang

Ali Amin

Anthony Mega

Dragan Golijanin

Boris Gershman

Affiliations

Soon will be listed here.

Abstract

Introduction And Objectives: In recent years, there has been a shift to minimally invasive partial nephrectomy (MIPN) with the dissemination of robot-assisted technology. However, contemporary data on the comparative morbidity of open partial nephrectomy (OPN) and MIPN are lacking. We, therefore, evaluated the perioperative morbidity of OPN and MIPN using a contemporary national cohort.

Methods: We identified 13,658 patients aged 18 to 89 who underwent PN from 2010 to 2015 in the National Surgical Quality Improvement Program (NSQIP) database, of whom 9018 (66.0%) underwent MIPN. The associations of MIPN with 30-day morbidity were evaluated using logistic regression, adjusted for patient features.

Results: Median age at surgery was 60 (interquartile range [IQR] 51, 68) years. Overall, 30-day complications occurred in 6.7% of patients. Compared with OPN, MIPN was associated with lower rates of 30-day complications (4.9% vs 10.1%, p < 0.0001), perioperative blood transfusion (3.8% vs 12.5%, p < 0.0001), prolonged hospitalization (5.6% vs 23.4%, p < 0.0001), readmission (4.4% vs 7.8%, p < 0.0001), reoperation (1.8% vs 3.2%, p < 0.0001), and 30-day mortality (0.3% vs 0.6%, p = 0.001). On multivariable analysis, MIPN was independently associated with a reduced risk of 30-day complications (odds ratio [OR] 0.46, p < 0.0001), perioperative blood transfusion (OR 0.27, p < 0.0001), prolonged hospitalization (OR 0.19, p < 0.0001), readmission (OR 0.59, p < 0.0001), and reoperation (OR 0.57, p < 0.0001). Postoperative complications occurred predominantly early after surgery, whereas hospital readmissions and reoperation occurred at a consistent rate.

Conclusions: In this contemporary national cohort, MIPN was independently associated with reduced rates of 30-day complications, perioperative blood transfusion, prolonged hospitalization, hospital readmission, and reoperation, compared with OPN.

Citing Articles

Asymptomatic bacteriuria prior to partial and radical nephrectomy: To screen or not to screen? Results from the national and multicenter TOCUS database.

Ayoub E, Kutchukian S, Bigot P, Dinh A, Gondran-Tellier B, Robin H World J Urol. 2024; 42(1):179.

PMID: 38507063 DOI: 10.1007/s00345-024-04853-1.

Complications after partial nephrectomy: robotics overcomes open surgery and laparoscopy: the PMSI French national database.

Bic A, Mazeaud C, Salleron J, Bannay A, Balkau B, Larose C BMC Urol. 2023; 23(1):146.

PMID: 37715175 PMC: 10502976. DOI: 10.1186/s12894-023-01322-6.

Patient Factors Impacting Perioperative Outcomes for T1b-T2 Localized Renal Cell Carcinoma May Guide Decision for Partial versus Radical Nephrectomy.

Shah Y, Simhal R, Wang K, Goldberg H, Lallas C, Chandrasekar T J Clin Med. 2023; 12(1).

PMID: 36614976 PMC: 9821707. DOI: 10.3390/jcm12010175.

Surgical Complications Requiring Reoperation in Open Versus Minimally Invasive Radical Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program.

El-Asmar J, Ayoub C, Kfoury P, Abou-Mrad A, El-Hajj A World J Surg. 2022; 47(4):856-862.

PMID: 36587175 DOI: 10.1007/s00268-022-06869-3.

Clinical Profile and Outcome of Patients Operated on for Renal Cell Carcinoma: Experience from a Tertiary Care Center in a Developing Country.

Adem R, Hassen S, Abdulaziz M, Ahmed A, Jemberie A, Gebeyehu Y Res Rep Urol. 2022; 14:389-397.

PMID: 36394071 PMC: 9661989. DOI: 10.2147/RRU.S376720.

References

Marszalek M, Meixl H, Polajnar M, Rauchenwald M, Jeschke K, Madersbacher S . Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol. 2009; 55(5):1171-8. DOI: 10.1016/j.eururo.2009.01.042. View

Gill I, Matin S, Desai M, Kaouk J, Steinberg A, Mascha E . Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol. 2003; 170(1):64-8. DOI: 10.1097/01.ju.0000072272.02322.ff. View

Ficarra V, Minervini A, Antonelli A, Bhayani S, Guazzoni G, Longo N . A multicentre matched-pair analysis comparing robot-assisted versus open partial nephrectomy. BJU Int. 2013; 113(6):936-41. DOI: 10.1111/bju.12570. View

Tan H, Wolf Jr J, Ye Z, Hafez K, Miller D . Population level assessment of hospital based outcomes following laparoscopic versus open partial nephrectomy during the adoption of minimally invasive surgery. J Urol. 2013; 191(5):1231-7. DOI: 10.1016/j.juro.2013.11.002. View

Peyronnet B, Seisen T, Oger E, Vaessen C, Grassano Y, Benoit T . Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors. Ann Surg Oncol. 2016; 23(13):4277-4283. DOI: 10.1245/s10434-016-5411-0. View

Chandra A, Snider J, Wu Y, Jena A, Goldman D . Robot-assisted surgery for kidney cancer increased access to a procedure that can reduce mortality and renal failure. Health Aff (Millwood). 2015; 34(2):220-8. DOI: 10.1377/hlthaff.2014.0986. View

Sun M, Abdollah F, Shariat S, Schmitges J, Trinh Q, Tian Z . Propensity-score matched comparison of complications, blood transfusions, length of stay, and in-hospital mortality between open and laparoscopic partial nephrectomy: a national series. Eur J Surg Oncol. 2011; 38(1):80-7. DOI: 10.1016/j.ejso.2011.09.035. View

Beasley K, Al Omar M, Shaikh A, Bochinski D, Khakhar A, Izawa J . Laparoscopic versus open partial nephrectomy. Urology. 2004; 64(3):458-61. DOI: 10.1016/j.urology.2004.04.028. View

Lucas S, Mellon M, Erntsberger L, Sundaram C . A comparison of robotic, laparoscopic and open partial nephrectomy. JSLS. 2013; 16(4):581-7. PMC: 3558896. DOI: 10.4293/108680812X13462882737177. View

10.

Weinberg A, Wright J, Whalen M, Paulucci D, Woldu S, Berger S . Use of Partial Nephrectomy after Acquisition of a Surgical Robot: A Population Based Study. Urol Pract. 2023; 3(6):430-436. DOI: 10.1016/j.urpr.2015.10.001. View

11.

Kim S, Murad M, Thompson R, Boorjian S, Weight C, Han L . Comparative Effectiveness for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumors: A Systematic Review and Meta-Analysis. J Urol. 2012; . DOI: 10.1016/j.juro.2012.10.026. View

12.

Kardos S, Gross C, Shah N, Schulam P, Trinh Q, Smaldone M . Association of type of renal surgery and access to robotic technology for kidney cancer: results from a population-based cohort. BJU Int. 2014; 114(4):549-54. DOI: 10.1111/bju.12711. View

13.

Sood A, Abdollah F, Sammon J, Kapoor V, Rogers C, Jeong W . An evaluation of the timing of surgical complications following nephrectomy: data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). World J Urol. 2015; 33(12):2031-8. DOI: 10.1007/s00345-015-1564-x. View

14.

Ghani K, Sukumar S, Sammon J, Rogers C, Trinh Q, Menon M . Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the nationwide inpatient sample. J Urol. 2013; 191(4):907-12. DOI: 10.1016/j.juro.2013.10.099. View

15.

Gill I, Kavoussi L, Lane B, Blute M, Babineau D, Colombo Jr J . Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007; 178(1):41-6. DOI: 10.1016/j.juro.2007.03.038. View

16.

Liu J, Leppert J, Maxwell B, Panousis P, Chung B . Trends and perioperative outcomes for laparoscopic and robotic nephrectomy using the National Surgical Quality Improvement Program (NSQIP) database. Urol Oncol. 2013; 32(4):473-9. DOI: 10.1016/j.urolonc.2013.09.012. View

17.

Minervini A, Vittori G, Antonelli A, Celia A, Crivellaro S, Dente D . Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications. World J Urol. 2013; 32(1):287-93. DOI: 10.1007/s00345-013-1136-x. View

18.

Becker A, Pradel L, Kluth L, Schmid M, Eichelberg C, Ahyai S . Laparoscopic versus open partial nephrectomy for clinical T1 renal masses: no impact of surgical approach on perioperative complications and long-term postoperative quality of life. World J Urol. 2014; 33(3):421-6. DOI: 10.1007/s00345-014-1318-1. View

19.

Patel H, Mullins J, Pierorazio P, Jayram G, Cohen J, Matlaga B . Trends in renal surgery: robotic technology is associated with increased use of partial nephrectomy. J Urol. 2012; 189(4):1229-35. DOI: 10.1016/j.juro.2012.10.024. View

20.

Kern S, Lustik M, McMann L, Thibault G, Sterbis J . Comparison of outcomes after minimally invasive versus open partial nephrectomy with respect to trainee involvement utilizing the American College of Surgeons National Surgical Quality Improvement Program. J Endourol. 2013; 28(1):40-7. DOI: 10.1089/end.2013.0051. View