Early Clinical and Economic Outcomes of Patients Undergoing Living Donor Nephrectomy in the United States
Early Clinical and Economic Outcomes of Patients Undergoing Living Donor Nephrectomy in the United States
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DOI：
10.1001/archsurg.2010.17
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发表时间：
2010-04-01
影响因子：
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通讯作者：
Sosa, Julie Ann
中科院分区：
文献类型：
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作者：
Friedman, Amy L.;Cheung, Kevin;Sosa, Julie Ann
背景：由于对活体供者安全的担忧，最大化肾移植的努力受到了影响。存在病例系列和中心调查，但缺乏全国汇总数据。我们试图确定活体供者肾切除术后早期临床和经济结果的预测因素。设计：使用1999-2005年全国住院样本的医疗成本和利用项目的出院数据进行了一项回顾性横断面分析。病例由国际疾病分类第九次修订(ICD-9)编码确定。使用二元和多元回归分析患者和提供者特征的临床和经济结果。单位：医疗保健成本和利用项目全国住院样本。患者：接受ICD-9编码的活体供肾切除的患者。干预：使用二元和多元回归分析患者和提供者特征的临床和经济结果。主要观察指标：住院并发症、死亡率、平均住院时间(LOS)和平均总住院费用。结果：共有6320例患者，死亡率为0，并发症发生率为18.4%。平均(SD)LOS为3.3(0.3)天，平均住院费用为10708美元(505美元)。供者并发症的独立预测因素包括年龄较大(优势比[OR]，1.01)、男性(OR，1.19)、Charlson共病指数至少为1(OR，1.49)、肥胖(OR，1.76)、中等规模医院(OR，1.88)和低容量医院(OR，1.37)。较长时间LOS的预测因素包括年龄较大、女性、Charlson评分至少为1、家庭收入较低、低容量医院和城市医院以及低容量外科医生。结论：肾脏捐献与低死亡率和18%的并发症发生率有关。高龄或肥胖者的捐献与更高的风险相关。知情同意应包括对这些风险的讨论。
Background: Efforts to maximize kidney transplantation are tempered by concern for the live donor's safety. Case series and center surveys exist, but national aggregate data are lacking. We sought to determine predictors of early clinical and economic outcomes following living donor nephrectomy.Design: A retrospective cross-sectional analysis using 1999-2005 discharge data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample was performed. Cases were identified by International Classification of Diseases, Ninth Revision (ICD-9), codes. Clinical and economic outcomes were analyzed with regard to patient and provider characteristics using bivariate and multivariate regression analyses.Setting: Healthcare Cost and Utilization Project Nationwide Inpatient Sample.Patients: Patients undergoing living donor nephrectomy, identified by the ICD-9 codes.Interventions: Clinical and economic outcomes were analyzed with regard to patient and provider characteristics using bivariate and multivariate regression analyses.Main Outcome Measures: In-hospital complications, mortality, mean length of stay (LOS), and mean total hospital costs.Results: A total of 6320 cases were identified with 0% mortality and a complication rate of 18.4%. The mean (SD) LOS was 3.3 (0.3) days, and the mean inpatient cost was $10 708 ($505). Independent predictors of donor complications included older age (odds ratio [OR], 1.01), male sex (OR, 1.19), Charlson Comorbidity Index of at least 1 (OR, 1.49), obesity (OR, 1.76), medium-size hospitals (OR, 1.88), and low-volume hospitals (OR, 1.37). Predictors of longer LOS included older age, female sex, Charlson score of at least 1, lower household income, low-volume and urban hospitals, and low-volume surgeons.Conclusions: Kidney donation is associated with a low mortality rate but an 18% complication rate. Donation by those with advanced age or obesity is associated with higher risks. Informed consent should include discussion of these risks.