To examine critical care therapy rates after cytoreductive nephrectomy in metastatic kidney cancer patients.
Relying on the National Inpatient Sample (2000-2019), we addressed critical care therapy use (total parenteral nutrition, invasive mechanical ventilation, renal replacement therapy, percutaneous endoscopic gastrostomy tube insertion, and tracheostomy) and in-hospital mortality in surgically treated metastatic kidney cancer patients. Estimated annual percentage changes and multivariable logistic regression models were fitted.
None.
Of 10,915 patients, 802 (7.3%) received critical care therapy and 249 (2.4%) died in-hospital. Over time, critical care therapy rates did not differ significantly (6.6% in 2000 to 5.7% in 2019; p = 0.07), while in-hospital mortality decreased from 2.3% to 1.9% (p = 0.004). Age 71 years old or older (odds ratio [OR], 1.43; p < 0.001) and higher comorbidity burden (Charlson Comorbidity Index [CCI] ≥ 3: OR, 2.92; p < 0.001 and CCI 1-2: OR, 1.45; p < 0.001) independently predicted higher critical care therapy rates. Conversely, partial nephrectomy (OR, 0.51; p = 0.003) and minimally invasive surgery (OR, 0.33; p < 0.001) predicted lower critical care therapy rates. Virtually the same associations were recorded for in-hospital mortality.
After cytoreductive nephrectomy, critical care therapy rate was 7.3% vs. in-hospital mortality was 2.4%. Of patients at highest risk of critical care therapy need were those with CCI greater than or equal to 3 and those 71 years old or older. Ideally, these patients should represent targets for thorough assessment of risk factors for complications before cytoreductive nephrectomy.
Critical care medicine. 2024 Nov 14 [Epub]
Carolin Siech, Mario de Angelis, Letizia Maria Ippolita Jannello, Francesco Di Bello, Natali Rodriguez Peñaranda, Jordan A Goyal, Zhe Tian, Fred Saad, Shahrokh F Shariat, Stefano Puliatti, Nicola Longo, Ottavio de Cobelli, Alberto Briganti, Benedikt Hoeh, Philipp Mandel, Luis A Kluth, Felix K H Chun, Pierre I Karakiewicz
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, AOU di Modena, University of Modena and Reggio Emilia, Modena, Italy., Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy., Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy., Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany.