Mp56-13 Hospital Case Volume Distribution and Outcomes for Patients Undergoing Radical Nephrectomy With Ivc or Intra-Atrial Tumor Thrombus: Data From the National Inpatient Sample

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP56)1 May 2024MP56-13 HOSPITAL CASE VOLUME DISTRIBUTION AND OUTCOMES FOR PATIENTS UNDERGOING RADICAL NEPHRECTOMY WITH IVC OR INTRA-ATRIAL TUMOR THROMBUS: DATA FROM THE NATIONAL INPATIENT SAMPLE Grant M. Henning, Ekamjit S. Deol, Spyridon P. Basourakos, Reza Nabavizadeh, R. Houston Thompson, Stephen A. Boorjian, Bradley C. Leibovich, and Vidit Sharma Grant M. HenningGrant M. Henning , Ekamjit S. DeolEkamjit S. Deol , Spyridon P. BasourakosSpyridon P. Basourakos , Reza NabavizadehReza Nabavizadeh , R. Houston ThompsonR. Houston Thompson , Stephen A. BoorjianStephen A. Boorjian , Bradley C. LeibovichBradley C. Leibovich , and Vidit SharmaVidit Sharma View All Author Informationhttps://doi.org/10.1097/01.JU.0001008940.44711.d4.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Outcomes of surgical treatment for renal cell carcinoma (RCC) with venous tumor thrombus (VTT) have been largely described by select, high-volume centers. We examined a nationally representative all-payer hospital database to estimate the incidence of complications from IVC and cardiac VTT during radical nephrectomy (RN) and to characterize the impact of hospital caseload on outcomes. METHODS: The National Inpatient Survey (NIS) database was queried between 2016-2020 for patients with RCC undergoing RN to identify significant intraoperative IVC manipulation or concomitant cardiotomy for VTT removal. Annual hospital caseloads (AHC) of IVC and cardiac VTT were examined to characterize centralization of care. Primary outcomes were Clavien-Dindo grade 3-5 complications. Multivariable logistic regressions were used to characterize the association of VTT and AHC with major complications. RESULTS: Of 111,785 RNs identified, 3.3% (N=3691) had significant IVC manipulation and 0.3% (N=335) had cardiac involvement. IVC and cardiac involvement were associated with increased complications for all Clavien-Dindo grades (Figure 1A). On multivariable regression, IVC manipulation (OR 1.56, p<0.01) and cardiac involvement (OR 4.31, p<0.01) remained associated with major complications. Approximately 82% of cases with IVC manipulation or cardiac involvement were performed at hospitals performing fewer than 10 such cases per year (Figure 1B). At the same time, the risk of major complications was significantly lower for cases performed where the AHC exceeded 10 on both chi-squared analysis (8.7% vs 17.6%, p<0.01) and multivariable regression (OR 0.62, p=0.04). CONCLUSIONS: 3.6% of RCs require significant IVC or cardiac surgical intervention during RN and these maneuvers are associated with a higher rate of major complications. The majority of these cases are performed at centers doing less than 10 cases per year. Efforts for centralization of care for RN with significant VTT should be continued. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e931 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Grant M. Henning More articles by this author Ekamjit S. Deol More articles by this author Spyridon P. Basourakos More articles by this author Reza Nabavizadeh More articles by this author R. Houston Thompson More articles by this author Stephen A. Boorjian More articles by this author Bradley C. Leibovich More articles by this author Vidit Sharma More articles by this author Expand All Advertisement PDF downloadLoading ...