PURPOSE:We examined the impact of hospital volume on short-term outcomes after nephrectomy for nonmetastatic renal cell carcinoma.
MATERIALS AND METHODS: Using the Nationwide Inpatient Sample we identified 48,172 patients with nonmetastatic renal cell carcinoma treated with nephrectomy (1998 to 2007). Postoperative complications, blood transfusions, prolonged length of stay and in-hospital mortality were examined. Stratification was performed according to teaching status, nephrectomy type (partial vs radical nephrectomy) and surgical approach (open vs laparoscopic). Multivariable logistic regression models were fitted.
RESULTS: Patients treated at high volume centers were younger and healthier at nephrectomy. High hospital volume predicted lower blood transfusion rates (8.5% vs 9.7% vs 11.8%), postoperative complications (14.4% vs 16.6% vs 17.2%) and shorter length of stay (43.1% vs 49.8% vs 54.0%, all p < 0.001). In multivariable analyses stratified according to teaching status, nephrectomy type and surgical approach, high hospital volume was an independent predictor of lower rates of postoperative complications (OR 0.73-0.88), blood transfusions (OR 0.71-0.78) and prolonged length of stay (OR 0.76-0.89, all p < 0.001). Exceptions were postoperative complications at nonteaching centers (OR 0.94, p >0.05) and blood transfusions in nephrectomies performed laparoscopically (OR 0.68, p >0.05).
CONCLUSIONS: On average, high hospital volume results in more favorable outcomes during hospitalization after nephrectomy.
Written by:
Sun M, Bianchi M, Trinh QD, Abdollah F, Schmitges J, Jeldres C, Shariat SF, Graefen M, Montorsi F, Perrotte P, Karakiewicz PI. Are you the author?
University of Montreal Health Center, Montreal, Quebec, Canada.
Reference: J Urol. 2012 Feb;187(2):405-10.
doi: 10.1016/j.juro.2011.10.025
PubMed Abstract
PMID: 22177151
