Patient factors associated with 30-day complications after partial nephrectomy: A contemporary update.

INTRODUCTION: Patient-level factors associated with perioperative complications after partial nephrectomy (PN) have not been well described in a contemporary series.

METHODS: Single-institution retrospective study evaluating patients undergoing open, laparoscopic, and robotic PN between 2001 and 2012. Univariable and multivariable logistic regression models were evaluated to assess factors associated with complications within 30 days of surgery.

RESULTS: We identified 1,763 patients who underwent 1,773 PNs between 2001 and 2012. From 2001 to 2006, 766 PNs were performed (85% open, 15% laparoscopic, and<1% robotic); in contrast, from 2007 to 2012, 1,007 PNs were performed (75% open, 8% laparoscopic, and 17% robotic); P<0.001. Overall, 241 (14%) PNs resulted in an early surgical complication. Patients undergoing a minimally invasive approach had smaller tumors (P<0.001), were less likely to have a solitary kidney (P<0.001), and had a lower Charlson score (P = 0.004). On multivariable analysis, factors independently associated with an increased risk of any complication included male sex (odds ratio [OR] = 1.40), solitary kidney (OR = 1.71), estimated glomerular filtration rate (OR = 2.89 for estimated glomerular filtration rate<30), Charlson score (OR = 1.97 for Charlson score≥3), and tumor size (OR = 1.12 for each 1-cm increase in tumor size); meanwhile, laparoscopic and robotic approaches were associated with a lower risk for complication (OR = 0.017 and 0.016, respectively), all P< 0.05.

CONCLUSION: Several patient-level factors are associated with 30-day complications after PN, regardless of surgical approach. These data may inform counseling before PN, including potential identification and selection of high-risk surgical candidates for percutaneous ablative approaches.