Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

Vanessa A Lukas; Rahul Dutta; Ashok K Hemal; Matvey Tsivian; Timothy E Craven; Nicholas A Deebel; David D Thiel; Ram Anil Pathak

doi:10.1016/j.ajur.2022.06.004

Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

Asian J Urol. 2024 Jan;11(1):72-79. doi: 10.1016/j.ajur.2022.06.004. Epub 2022 Sep 9.

Authors

Vanessa A Lukas¹, Rahul Dutta², Ashok K Hemal², Matvey Tsivian², Timothy E Craven², Nicholas A Deebel², David D Thiel³, Ram Anil Pathak³

Affiliations

¹ Brigham and Women's Hospital, Division of Urology, Department of Surgery, 75 Francis Street, Boston, MA, USA.
² Atrium Health Wake Forest Baptist Medical Center, Department of Urology, 1 Medical Center Blvd, Winston-Salem, NC, USA.
³ Mayo Clinic Florida, Department of Urology, 4500 San Pablo Road, Jacksonville, FL, USA.

Abstract

Objective: We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre- and peri-operative variables associated with length of stay (LOS) greater than 3 days and readmission within 30 days.

Methods: Records from 2008 to 2018 for "laparoscopy, surgical; partial nephrectomy" for prolonged LOS and readmission cohorts were compiled. Univariate analysis with Chi-square, t-tests, and multivariable logistic regression analysis with odds ratios (ORs), p-values, and 95% confidence intervals assessed statistical associations.

Results: Totally, 20 306 records for LOS greater than 3 days and 15 854 for readmission within 30 days were available. Univariate and multivariable analysis exhibited similar results. For LOS greater than 3 days, undergoing non-elective surgery (OR=5.247), transfusion of greater than four units within 72 h prior to surgery (OR=5.072), pre-operative renal failure or dialysis (OR=2.941), and poor pre-operative functional status (OR=2.540) exhibited the strongest statistically significant associations. For hospital readmission within 30 days, loss in body weight greater than 10% in 6 months prior to surgery (OR=2.227) and bleeding disorders (OR=2.081) exhibited strongest statistically significant associations.

Conclusion: Multiple pre- and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data. Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection, optimization strategies, and patient education.

Keywords: Hospital readmission; Length of stay; Minimally-invasive partial nephrectomy; The American College of Surgeons National Surgical Quality Improvement Program.