Patient and disease factors predictive of adverse perioperative outcomes after nephrectomy
Patient and disease factors predictive of adverse perioperative outcomes after nephrectomy
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DOI：
10.1308/rcsann.2016.0126
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发表时间：
2016-05-01
影响因子：
1.4
通讯作者：
Keeley, F. X.
中科院分区：
文献类型：
--
作者：
Henderson, J. M.;Pitcher, D.;Keeley, F. X.
引言 本研究的目的是利用英国泌尿外科医生协会 (BAUS) 审核数据库确定预测肾切除术后不良围手术期结果的患者和疾病因素。 方法纳入 2012 年进入 BAUS 数据库的所有肾切除术，并选择 10 个患者或疾病因素进行分析。使用 Logistic 回归计算每个变量的受试者工作特征曲线 (AUC) 下面积（0.5 = 不优于机会，1.0 = 完美预测），并使用 500 个引导样本来确定变量选择。 结果 捕获了 2012 年 6,031 例肾切除术的数据。世界卫生组织体能状态 (WHO-PS) (AUC: 0.733) 和贫血 (AUC: 0.696) 为最 单变量分析中 30 天死亡率的重要预测因素。 WHO-PS（AUC：0.626）和贫血（AUC：0.590）也预测了 Clavien-Dindo III-V 级并发症。贫血（AUC：0.722）和临床 T 分期（AUC：0.713）预测需要输血。 结论 血尿、较差的 WHO-PS 和较高的 TNM（肿瘤、淋巴结、转移）分期的临床表现可预测肾切除术后不良的围手术期结果。这项研究使用外科医生收集的数据，而不是管理数据库，后者在数据领域的准确性和广度方面可能具有优势。这些数据构成了术前患者咨询和肾切除术知情同意的基础。它们还可以用作外科医生和医院比较自己结果的标准。
INTRODUCTION The aim of this study was to determine the patient and disease factors predictive of adverse perioperative outcomes after nephrectomy using the British Association of Urological Surgeons (BAUS) audit database.METHODS All nephrectomies entered on the BAUS database for the year 2012 were included and ten patient or disease factors were selected for analysis. Logistic regression was used to calculate the area under the receiver operating characteristic curve (AUC) (0.5 = no better than chance, 1.0 = perfect prediction) for each variable and 500 bootstrap samples were used to determine variable selection.RESULTS Data were captured for 6,031 nephrectomies in 2012. World Health Organization performance status (WHO-PS) (AUC: 0.733) and anaemia (AUC: 0.696) were the most significant predictors of 30-day mortality in univariate analysis. WHO-PS (AUC: 0.626) and anaemia (AUC: 0.590) also predicted complications classified as Clavien-Dindo grades III-V. Anaemia (AUC: 0.722) and clinical T stage (AUC: 0.713) predicted need for transfusion.CONCLUSIONS Adverse perioperative outcomes after nephrectomy are predicted by clinical presentation with haematuria, poor WHO-PS and higher TNM (tumour, lymph nodes, metastasis) stage. This study used surgeon collected data as opposed to an administrative database, which may have advantages in terms of accuracy and breadth of data fields. These data form a basis for preoperative patient counselling and informed consent for nephrectomy. They can also be used as a standard against which surgeons and hospitals can compare their own results.