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dc.contributor.authorWebster, Jonathan
dc.date.accessioned2019-12-04T08:34:32Z
dc.date.created2019-05
dc.date.issued2019-07-25
dc.date.submitted2019
dc.identifier.citationWebster, Jonathan. 2019. Age Stratified Readmission Rates, Differences in Length of Stay and Medical Morbidity After Radical Nephrectomy Using the ACS-NSQIP Database. Doctoral dissertation, Harvard Medical School.
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:41971536*
dc.description.abstractIntroduction 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.
dc.description.sponsorshipScholarly Project
dc.format.mimetypeapplication/pdf
dc.language.isoen
dash.licenseLAA
dc.subjectKeywords: urology
dc.subjectrenal cell carcinoma
dc.subjectradical nephrectomy
dc.subjectquality improvement
dc.subjectcomplications
dc.subjectNSQIP
dc.subjectreadmission
dc.subjectAge stratified
dc.titleAge Stratified Readmission Rates, Differences in Length of Stay and Medical Morbidity After Radical Nephrectomy Using the ACS-NSQIP Database
dc.typeThesis or Dissertation
dash.depositing.authorWebster, Jonathan
dc.date.available2019-12-04T08:34:32Z
thesis.degree.date2019
thesis.degree.grantorHarvard Medical School
thesis.degree.grantorHarvard Medical School
thesis.degree.levelDoctoral
thesis.degree.levelDoctoral
thesis.degree.nameDoctor of Medicine
thesis.degree.nameDoctor of Medicine
dc.type.materialtext
dash.identifier.vireo
dash.author.emailwebster.jonathane@gmail.com


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