Complications and Failure to Rescue After Laparoscopic Versus Open Radical Nephrectomy
Complications and Failure to Rescue After Laparoscopic Versus Open Radical Nephrectomy
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DOI：
10.1016/j.juro.2011.05.074
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发表时间：
2011-10-01
影响因子：
6.6
通讯作者：
Miller, David C.
中科院分区：
文献类型：
--
作者：
Tan, Hung-Jui;Wolf, J. Stuart, Jr.;Miller, David C.
目的：由于据我们所知，腹腔镜对根治性肾切除术后发病率和死亡率的人群水平影响尚不清楚，我们比较了术后并发症和抢救失败率腹腔镜与开放性根治性肾切除术治疗患者的死亡率（并发症患者的死亡率）。使用相关的SEER（监测、流行病学和最终结果）-医疗保险数据，我们确定了2000年至2005年接受腹腔镜或开放性根治性肾切除术治疗的肾癌患者。在测量术后并发症和抢救失败的频率后，我们拟合多变量logistic回归模型，以估计这些结果与手术方法的相关性，调整患者特征，癌症严重程度和手术年。我们还评估了病例数量、并发症和抢救失败之间的关系。结果：我们确定了2,108例（26%）和5,895例（74%）分别接受腹腔镜和开放性根治性肾切除术的患者。总的并发症发生率和抢救失败率分别为36.9%和5.3%。腹腔镜根治性肾切除术后任何严重内科和外科并发症的预测概率分别比开放根治性肾切除术低15%、12%、13%和23%（均p < 0.05）。尽管腹腔镜根治性肾切除术治疗的患者并发症较少，但抢救失败的可能性更大（7.6% vs 4.6%，p = 0.010）。高容量的外科医生和医院有较低的失败率抢救根治性肾切除术治疗的患者（每个p < 0.05），但不与开放根治性nephrotectory.Conclusions：支持腹腔镜手术的发病率下降，根治性肾切除术治疗的患者有较少的并发症比那些接受开放根治性nephrotectory. Conclusions。然而，在根治性肾切除术后并发症的患者中，抢救失败更为常见，这表明这些事件可能更难识别和成功管理，尤其是在经验不足的外科医生和医院中。
Purpose: Since to our knowledge the population level impact of laparoscopy on post-radical nephrectomy morbidity and mortality remains unknown, we compared the rates of postoperative complications and failure to rescue (the fatality rate in patients with a complication) in patients treated with laparoscopic vs open radical nephrectomy.Materials and Methods: Using linked SEER (Surveillance, Epidemiology and End Results)-Medicare data we identified patients with kidney cancer who were treated with laparoscopic or open radical nephrectomy from 2000 through 2005. After measuring the frequency of postoperative complications and failure to rescue we fit multivariate logistic regression models to estimate the association of these outcomes with surgical approach, adjusting for patient characteristics, cancer severity and surgery year. We also assessed the relationship between case volume, complications and failure to rescue.Results: We identified 2,108 (26%) and 5,895 patients (74%) treated with laparoscopic and open radical nephrectomy, respectively. The overall rates of complications and failure to rescue were 36.9% and 5.3%, respectively. The predicted probability of any, major, medical and surgical complications was 15%, 12%, 13% and 23% lower, respectively, after laparoscopic than after open radical nephrectomy (each p < 0.05). Despite less frequent complications patients treated with laparoscopic radical nephrectomy had a greater probability of failure to rescue (7.6% vs 4.6%, p = 0.010). Higher volume surgeons and hospitals had a lower rate of failure to rescue in patients treated with radical nephrectomy (each p < 0.05) but not with open radical nephrectomy.Conclusions: Supporting the decreased morbidity of laparoscopy, patients treated with radical nephrectomy had fewer complications than those who underwent open radical nephrectomy. However, failure to rescue was more common in patients with a complication after radical nephrectomy, suggesting that these events may be more difficult to recognize and manage successfully, especially among less experienced surgeons and hospitals.