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J Urol. 2012 Feb;187(2):405-10. doi: 10.1016/j.juro.2011.10.025. Epub 2011 Dec 15.

Hospital volume is a determinant of postoperative complications, blood transfusion and length of stay after radical or partial nephrectomy.

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1
University of Montreal Health Center, Montreal, Quebec, Canada. mcw.sun@umontreal.ca

Abstract

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.

PMID:
22177151
DOI:
10.1016/j.juro.2011.10.025
[Indexed for MEDLINE]
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