Cardiovascular events after kidney cancer surgery: insights from a comprehensive national database

BACKGROUND: The aim of this study is to compare the occurrence of major cardiovascular events (MCEs) after partial nephrectomy (PN) and radical nephrectomy (RN), and to identify risk factors for their development, including the impact of social determinants of health (SDOH). METHODS: We used the PearlDiver™ Mariner database (Pearl-Diver Technologies, Colorado Springs, CO, USA) for this analysis. At 1- and 5-year after surgery, the following MCEs were described by using proper ICD-9/10 diagnostic codes: myocardial infarction, cerebrovascular diseases, congestive heart failure, and peripheral vascular diseases. Risk factors for overall risk of MCEs within 5 years after surgery were assessed using multivariable logistic regression analysis. RESULTS: A total of 44,455 and 46,295 patients underwent PN and RN, respectively. Statistically significant differences were reported with RN group being characterized by higher rates per each of these events. At a multivariable analysis, RN was associated with a significantly greater likelihood of MCEs (OR 1.51, 95% CI 1.46-1.56, P=0.001), so as age at surgery, male gender, preoperative diabetes mellitus, hypertension and dyslipidemia, tobacco use, history of myocardial infarction and congestive heart failure, presence of SDOH and end-stage renal disease. Our study acknowledges limitations including potential misclassification and lack of detailed clinical data in the PearlDiver Mariner database. CONCLUSIONS: Kidney cancer surgery is associated with a non-negligible risk of MCEs. Even after taking into consideration comorbidities and history of cardiovascular diseases, RN continues to independently increase the risk of MCEs. Moreover, social disparities, as measured by the SDOH, play a crucial role in risk of MCEs in patients undergoing surgery for kidney cancer.