Partial and Radical Nephrectomy in Children, Adolescents, and Young Adults: Equivalent Readmissions and Postoperative Complications
M. Hassan Alkazemi, MS, Zachary R. Dionise, BA, Ruiyang Jiang, MD, Steven Wolf, MS, Gina-Maria Pomann, PhD, Elisabeth T. Tracy, MD, Henry E. Rice, MD, Jonathan C. Routh, MD, MPH.
Duke University, Durham, NC, USA.
BACKGROUND: Although the use of radical nephrectomy (RN) is the standard of care for most pediatric renal masses, there has been increasing interest in partial nephrectomy (PN) as an alternative. PN remains controversial and there is scarce national-level evidence to compare outcomes with RN. This study aims to characterize the quality measures of readmission and postoperative complication rates using a nationally representative database.
METHODS: The 2010-2014 Nationwide Readmissions Database (NRD) was used to obtain PN and RN select postoperative data. ICD-9-CM codes were used to identify children (<10 y), adolescents (10-19 y) and young adults (20-30 y) diagnosed with malignant renal tumors who were treated with a PN or RN. The presence of a 30-day readmission, occurrence of post-
operative complications, cost of procedure, and length of stay were studied. Weighted logistic regression models were fit to test for an association between surgical modality and either postoperative complications or 30-day readmission rates while adjusting for age, gender, insurance, income, hospital type, and comorbidity.
RESULTS: There were 4330 weighted encounters (1289 PN, 3041 RN) that met inclusion criteria: 50.8% were children, 7.2% were adolescents, and 42% were young adults. Young adults had the highest rates of PN, whereas children had the highest rates of RN (p<0.0001). Overall, no evidence was found to suggest a difference in odds between the type of nephrectomy performed and the presence of a 30-day readmission or postoperative complication. No evidence was found to suggest postoperative complication rates differed between RN and PN in all age groups. While PN was on average $9,000 cheaper compared to RN overall, its cost was similar to that of RN for children. Similarly, PN patients had on average a shorter overall length of stay compared to RN patients, but their length of stay was similar to that of children who underwent RN.
CONCLUSIONS: There was no evidence of a difference in odds between RN and PN in terms of postoperative readmissions or in-hospital complication rates. Additionally, we observed descriptive differences in both cost and length of stay between the surgical modalities across age groups.
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