The effect of gender on nephrectomy perioperative outcomes: a national survey.
ABSTRACT The effect of gender on complications after surgery is controversial. We examine the effect of gender on five short term nephrectomy outcomes.
Within the Health Care Utilization Project, Nationwide Inpatient Sample (NIS) we focused on nephrectomies performed within the most contemporary years (1998-2007). We tested the rates of blood transfusions, extended length of stay, in-hospital mortality, as well as intraoperative and postoperative complications, stratified according to gender. Multivariable logistic regression analyses fitted with general estimation equations for clustering among hospitals further adjusted for confounding factors. Separate multivariable analyses were performed for open radical nephrectomy (ORN), open partial nephrectomy (OPN), laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN).
Overall, 48172 nephrectomies were identified. Of those, female patients accounted 39.4% of cases (n = 18966). Female gender was associated with higher rates of blood transfusions (p < 0.001) and higher rates of prolonged length of stay (p < 0.001). Conversely, female gender was associated with lower rates of postoperative complications (p < 0.001) and in-hospital mortality (p = 0.015). In multivariable analyses, female patients had higher rates of blood transfusion (OR = 1.22, p < 0.001) but significantly lower rates of postoperative complications (OR = 0.81, p < 0.001) and in-hospital mortality. No statistically significant differences were recorded when accounting for intraoperative complications and length of stay beyond the median (all p > 0.05). Gender as a predictor of outcomes was most pronounced in OPN and LPN.
Nephrectomies performed in female patients are associated with lower rates of postoperative complications and in-hospital mortality. Conversely, blood transfusions rates are higher in these patients. Gender disparities in perioperative outcomes are most pronounced after OPN.
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ABSTRACT: Pure laparoscopic donor nephrectomy (LDN) is a unique intervention because it carries known risks and complications, yet carries no direct benefit to the donor. Therefore, it is critical to continually examine and improve quality of care. To identify factors affecting LDN outcomes and complications. A retrospective analysis of prospectively collected data for 1204 consecutive LDNs performed from March 2000 through August 2012. LDN performed at an academic training center. Using multivariable regression, we assessed the effect of age, sex, body mass index (BMI), laterality, and vascular variation on operative time, estimated blood loss (EBL), complications, and length of stay. The following variables were associated with longer operative time (data given as parameter estimate plus or minus the standard error): female sex (9.09±2.43; p<0.001), higher BMI (1.03±0.32; p=0.001), two (7.87±2.70; p=0.004) and three or more (22.45±7.13; p=0.002) versus one renal artery, and early renal arterial branching (5.67±2.82; p=0.045), while early renal arterial branching (7.81±3.85; p=0.043) was associated with higher EBL. Overall, 8.2% of LDNs experienced complications, and by modified Clavien classification, 74 (5.9%) were grade 1, 13 (1.1%) were grade 2a, 10 (0.8%) were grade 2b, and 2 (0.2%) were grade 2c. There were no grade 3 or 4 complications. Three or more renal arteries (odds ratio [OR]: 2.74; 95% CI, 1.05-7.16; p=0.04) and late renal vein confluence (OR: 2.42; 95% CI, 1.50-3.91; p=0.0003) were associated with more complications. Finally, we did not find an association of the independent variables with length of stay. A limitation is that warm ischemia time was not assessed. In our series, renal vascular variation prolonged operative time and was associated with more complications. While complicated donor anatomy is not a contraindication of LDN, surgical decision-making should take into consideration these results.European Urology 10/2013; 65(3). DOI:10.1016/j.eururo.2013.09.048 · 12.48 Impact Factor
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ABSTRACT: We determine the relationship between gender and surgical morbidity after radical nephrectomy (RN) and partial nephrectomy (PN) for renal masses on a population level.05/2014; 8(5-6):E311-6. DOI:10.5489/cuaj.1674