Age Stratified Readmission Rates, Differences in Length of Stay and Medical Morbidity After Radical Nephrectomy Using the ACS-NSQIP Database

Abstract

Introduction Renal cell carcinoma is the third most common malignancy seen by urologists. Surgery is an important, potentially curative treatment option for renal cell carcinoma. Age is an established, non-modifiable risk factor for the development of renal cell carcinoma. Using a national database, we aimed to examine age-stratified differences in readmissions, length of stay and medical complications for patients undergoing a radical nephrectomy. Methods All NSQIP-reported patients undergoing treatment for renal cell carcinoma (ICD-9=189.0) from 2012 to 2014 were identified. The resulting patients were sorted into open and laparoscopic approaches by primary operative CPT code. Next, those resulting patients were stratified into two groups by age. Bivariate and multivariate analysis was used to compare patient demographics and to identify predictors for 30-day readmissions and post-operative complications. Results From 2012 to 2014, 4,514 NSQIP-reported patients underwent either an open or laparoscopic nephrectomy. Of these, 2,464 (54.6%) were performed on patients 64 or younger and 2,050 (45.4%) were performed on people over 65. The overall readmission rate among patients undergoing a radical nephrectomy was 6.2% (5.7% vs. 6.8%, p=0.14). Patients undergoing a radical nephrectomy over the age of 65 were statistically more likely to develop pneumonia (1.2% vs. 2.2%, p=0.01), receive a blood transfusion (15.4% vs. 19.4% p=0.0006) and have a hospital length of stay in the highest quartile (19.8% vs. 27.6%, p<0.0001). On multivariate logistic regression, age was found to be a predictor of post-operative infections (OR=1.34, p=0.02), cardiovascular complications (OR=1.36, p=0.0008), and increased length of stay (OR=1.66, p<0.0001). Conclusions This analysis demonstrates there is an increase in hospital length of stay, as well as post-operative complications in radical nephrectomy patients over 65.