Higher perioperative morbidity and in‐hospital mortality in patients with end‐stage renal disease undergoing nephrectomy for non‐metastatic kidney cancer: a population‐based analysis
Notice bibliographique
Résumé
UNLABELLED: What's known on the subject? and What does the study add? Patients with renal failure more frequently harbour RCC due to predisposing factors such as cystic disease of the kidney. The benefit of nephrectomy might be outweighed by adverse perioperative events, however, which may be more prevalent in patients with end-stage renal disease (ESRD). In a population-based study focusing on patients after non-elective colorectal surgery, patients with ESRD had an increased risk of mortality and complications. To date, small-scale studies have reported complication rates in patients with ESRD after nephrectomy for RCC with conflicting results. However, no formal contemporary analysis has been compiled within a nephrectomy cohort of adequate size. The present population-based case-control study showed that patients with ESRD are at substantially higher risk of in-hospital mortality and in-hospital complications. Specifically, we demonstrated higher cardiac-related complications, transfusion and haemorrhage/haematoma rates in patients with ESRD than in others. Moreover, patients with ESRD are more likely to have prolonged length of stay in hospital, and incur higher hospital charges. Based on the findings of the present study, use of biopsy and active surveillance for small, carefully selected renal masses might be considered in patients with ESRD at high risk of morbidity and mortality after surgery. OBJECTIVE: To examine the effect of end-stage renal disease (ESRD) on six short-term nephrectomy outcomes. PATIENTS AND METHODS: The Nationwide Inpatient Sample was used to assess the rates of blood transfusions, intra-operative and postoperative complications, length of hospital stay (LOS) within the highest quartile (>5 days), total hospital charges within the highest quartile (>$33 391) and in-hospital mortality. Propensity-based matching was performed to adjust for potential baseline differences between patients with ESRD and others. Multivariable logistic regression analyses further adjusted for confounding variables. RESULTS: Overall, 46 225 patients underwent open radical, open partial, laparoscopic radical or laparoscopic partial nephrectomy for non-metastatic kidney cancer between 1998 and 2007. Of those, 941 patients with ESRD were identified (2.0%). For patients with ESRD and others, the following rates were recorded, respectively: blood transfusions, 17.4 vs 9.1% (P < 0.001); intra-operative complications, 3.5 vs 3.3% (P = 0.81); postoperative complications, 19.2 vs 15.6% (P = 0.007); length of stay within the highest quartile, 55.4 vs 30.1% (P < 0.001); total hospital charges within the highest quartile, 50.4 vs 26.3% (P < 0.001); in-hospital mortality, 2.4 vs 0.5% (P < 0.001). In multivariable logistic regression analyses, patients with ESRD were more likely to receive a blood transfusion (odds ratio [OR] = 2.05, P < 0.001), to experience any postoperative complication (OR = 1.25, P = 0.019), to have a LOS within the highest quartile (OR = 3.06, P < 0.001), to have hospital charges within the highest quartile (OR = 3.10, P < 0.001), and to die during hospitalization (OR = 4.85, P < 0.001). CONCLUSIONS: Patients with ESRD are at substantially higher risk of adverse outcomes after nephrectomy. Most importantly, the in-hospital mortality rate is fivefold higher.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».