Who is at risk of death from nephrectomy? An analysis of thirty-day mortality after 21 380 nephrectomies in 3 years of the British Association of Urological Surgeons (BAUS) National Nephrectomy Audit

British Association of Urological Surgeons (BAUS)

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To ascertain contemporary overall and differential thirty-day mortality (TDM) rates after all types of nephrectomy in the UK, and to identify potential new risk factors for death.

PATIENTS AND METHODS: We conducted a retrospective analysis of the 110 deaths that occurred within 30 days of surgery out of the total of 21 380 nephrectomies performed, and calculated the odds ratio (OR) and 95% confidence interval (CI) for TDM based on peri-operative characteristics.

RESULTS: The overall TDM rate was 110/21380 (0.5%). The TDM rates after radical, partial, simple nephrectomy and nephro-ureterectomy were 0.6% (63/11057), 0.1% (4/3931), 0.4% (11/2819) and 0.9% (28/3091), respectively. TDM increased with age, stage, estimated blood loss (EBL), operating time and performance status. EBL of 1-2 L was associated with a greater risk of TDM than EBL of 2-5 L (OR 1.38; 95% CI 1.03-2.24). Conversion from minimally invasive surgery was associated with higher risk than non-conversion (OR 2.53; 95% CI 1.14-4.51. Curative surgery was safer than cytoreductive surgery (OR 0.31; 95% CI 0.18-0.54). There was an association between surgical volume and TDM.

CONCLUSIONS: This study provides contemporary insights into the true risks of all types of nephrectomy. The TDM rate after nephrectomy in the UK appears acceptably low at 0.5%. Established risk factors were confirmed and the following novel risk factors were identified: modest EBL (1-2 L) and conversion from minimally invasive surgery.

Original languageEnglish
Pages (from-to)358-364
Number of pages7
JournalBJU International
Volume120
Issue number3
Early online date24 Apr 2017
DOIs
Publication statusPublished - Sep 2017
Externally publishedYes

Bibliographical note

© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Keywords

  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Kidney Neoplasms/mortality
  • Male
  • Middle Aged
  • Nephrectomy/mortality
  • Retrospective Studies
  • Risk Factors

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