The effect of surgical approach on performance of lymphadenectomy and perioperative morbidity for radical nephroureterectomy

Shane M. Pearce, Joseph J Pariser, Sanjay G. Patel, Gary D. Steinberg, Arieh L. Shalhav, Norm D. Smith

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objectives: To examine the effect of surgical approach on regional lymphadenectomy (LND) performance and inpatient complications for radical nephroureterectomy (NU) using a national administrative database. Methods: The National Inpatient Sample (2009-2012) was used to identify patients who underwent NU for urothelial carcinoma. Cohorts were stratified by performance of LND. Covariates included patient demographics, comorbidity, hospital characteristics, hospital volume, performance of LND, surgical approach (open [ONU], laparoscopic [LNU], or robotic [RNU]), and complications. Multivariable logistic regression was used to identify factors associated with LND performance and complications. Results: A weighted population of 14,059 (85%) without LND and 2,560 (15%) with LND was identified. LND was more common in RNU (27%) compared with ONU (15%) and LNU (10%) (P<0.01). On multivariable analysis, when compared with ONU, RNU was associated with increased odds of LND performance (odds ratio [OR] = 1.9, 95% CI: [1.3-2.8]; P = 0.001), whereas LNU was associated with decreased odds of LND performance (OR = 0.6, 95% CI: [0.4-0.8]; P = 0.004). Multivariable analysis of risk factors for complications demonstrated lower odds of complications with RNU (OR = 0.6, 95% CI: [0.4-0.8]; P = 0.001), whereas performance of LND increased the risk of complications (OR = 1.3, 95% CI: [1.001-1.7]; P = 0.049). Conclusions: When compared with ONU, RNU increased the odds of LND performance and had a lower inpatient complication rate, whereas LNU reduced the odds of LND performance and had no significant effect on inpatient complication rates. Performance of LND was independently associated with higher inpatient complication rates.

Original languageEnglish (US)
Pages (from-to)121.e15-121.e21
JournalUrologic Oncology: Seminars and Original Investigations
Volume34
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

Fingerprint

Lymph Node Excision
Inpatients
Morbidity
Odds Ratio
Robotics
Comorbidity
Logistic Models
Demography
Databases
Carcinoma
Population

Keywords

  • Complications
  • Lymph node excision
  • Patterns of care
  • Treatment outcome
  • Upper urinary tract
  • Urothelial carcinoma

Cite this

The effect of surgical approach on performance of lymphadenectomy and perioperative morbidity for radical nephroureterectomy. / Pearce, Shane M.; Pariser, Joseph J; Patel, Sanjay G.; Steinberg, Gary D.; Shalhav, Arieh L.; Smith, Norm D.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 34, No. 3, 01.03.2016, p. 121.e15-121.e21.

Research output: Contribution to journalArticle

Pearce, Shane M. ; Pariser, Joseph J ; Patel, Sanjay G. ; Steinberg, Gary D. ; Shalhav, Arieh L. ; Smith, Norm D. / The effect of surgical approach on performance of lymphadenectomy and perioperative morbidity for radical nephroureterectomy. In: Urologic Oncology: Seminars and Original Investigations. 2016 ; Vol. 34, No. 3. pp. 121.e15-121.e21.
@article{16736b84b7b444c1bf7cb39042f69a0d,
title = "The effect of surgical approach on performance of lymphadenectomy and perioperative morbidity for radical nephroureterectomy",
abstract = "Objectives: To examine the effect of surgical approach on regional lymphadenectomy (LND) performance and inpatient complications for radical nephroureterectomy (NU) using a national administrative database. Methods: The National Inpatient Sample (2009-2012) was used to identify patients who underwent NU for urothelial carcinoma. Cohorts were stratified by performance of LND. Covariates included patient demographics, comorbidity, hospital characteristics, hospital volume, performance of LND, surgical approach (open [ONU], laparoscopic [LNU], or robotic [RNU]), and complications. Multivariable logistic regression was used to identify factors associated with LND performance and complications. Results: A weighted population of 14,059 (85{\%}) without LND and 2,560 (15{\%}) with LND was identified. LND was more common in RNU (27{\%}) compared with ONU (15{\%}) and LNU (10{\%}) (P<0.01). On multivariable analysis, when compared with ONU, RNU was associated with increased odds of LND performance (odds ratio [OR] = 1.9, 95{\%} CI: [1.3-2.8]; P = 0.001), whereas LNU was associated with decreased odds of LND performance (OR = 0.6, 95{\%} CI: [0.4-0.8]; P = 0.004). Multivariable analysis of risk factors for complications demonstrated lower odds of complications with RNU (OR = 0.6, 95{\%} CI: [0.4-0.8]; P = 0.001), whereas performance of LND increased the risk of complications (OR = 1.3, 95{\%} CI: [1.001-1.7]; P = 0.049). Conclusions: When compared with ONU, RNU increased the odds of LND performance and had a lower inpatient complication rate, whereas LNU reduced the odds of LND performance and had no significant effect on inpatient complication rates. Performance of LND was independently associated with higher inpatient complication rates.",
keywords = "Complications, Lymph node excision, Patterns of care, Treatment outcome, Upper urinary tract, Urothelial carcinoma",
author = "Pearce, {Shane M.} and Pariser, {Joseph J} and Patel, {Sanjay G.} and Steinberg, {Gary D.} and Shalhav, {Arieh L.} and Smith, {Norm D.}",
year = "2016",
month = "3",
day = "1",
doi = "10.1016/j.urolonc.2015.09.008",
language = "English (US)",
volume = "34",
pages = "121.e15--121.e21",
journal = "Urologic Oncology: Seminars and Original Investigations",
issn = "1078-1439",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - The effect of surgical approach on performance of lymphadenectomy and perioperative morbidity for radical nephroureterectomy

AU - Pearce, Shane M.

AU - Pariser, Joseph J

AU - Patel, Sanjay G.

AU - Steinberg, Gary D.

AU - Shalhav, Arieh L.

AU - Smith, Norm D.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Objectives: To examine the effect of surgical approach on regional lymphadenectomy (LND) performance and inpatient complications for radical nephroureterectomy (NU) using a national administrative database. Methods: The National Inpatient Sample (2009-2012) was used to identify patients who underwent NU for urothelial carcinoma. Cohorts were stratified by performance of LND. Covariates included patient demographics, comorbidity, hospital characteristics, hospital volume, performance of LND, surgical approach (open [ONU], laparoscopic [LNU], or robotic [RNU]), and complications. Multivariable logistic regression was used to identify factors associated with LND performance and complications. Results: A weighted population of 14,059 (85%) without LND and 2,560 (15%) with LND was identified. LND was more common in RNU (27%) compared with ONU (15%) and LNU (10%) (P<0.01). On multivariable analysis, when compared with ONU, RNU was associated with increased odds of LND performance (odds ratio [OR] = 1.9, 95% CI: [1.3-2.8]; P = 0.001), whereas LNU was associated with decreased odds of LND performance (OR = 0.6, 95% CI: [0.4-0.8]; P = 0.004). Multivariable analysis of risk factors for complications demonstrated lower odds of complications with RNU (OR = 0.6, 95% CI: [0.4-0.8]; P = 0.001), whereas performance of LND increased the risk of complications (OR = 1.3, 95% CI: [1.001-1.7]; P = 0.049). Conclusions: When compared with ONU, RNU increased the odds of LND performance and had a lower inpatient complication rate, whereas LNU reduced the odds of LND performance and had no significant effect on inpatient complication rates. Performance of LND was independently associated with higher inpatient complication rates.

AB - Objectives: To examine the effect of surgical approach on regional lymphadenectomy (LND) performance and inpatient complications for radical nephroureterectomy (NU) using a national administrative database. Methods: The National Inpatient Sample (2009-2012) was used to identify patients who underwent NU for urothelial carcinoma. Cohorts were stratified by performance of LND. Covariates included patient demographics, comorbidity, hospital characteristics, hospital volume, performance of LND, surgical approach (open [ONU], laparoscopic [LNU], or robotic [RNU]), and complications. Multivariable logistic regression was used to identify factors associated with LND performance and complications. Results: A weighted population of 14,059 (85%) without LND and 2,560 (15%) with LND was identified. LND was more common in RNU (27%) compared with ONU (15%) and LNU (10%) (P<0.01). On multivariable analysis, when compared with ONU, RNU was associated with increased odds of LND performance (odds ratio [OR] = 1.9, 95% CI: [1.3-2.8]; P = 0.001), whereas LNU was associated with decreased odds of LND performance (OR = 0.6, 95% CI: [0.4-0.8]; P = 0.004). Multivariable analysis of risk factors for complications demonstrated lower odds of complications with RNU (OR = 0.6, 95% CI: [0.4-0.8]; P = 0.001), whereas performance of LND increased the risk of complications (OR = 1.3, 95% CI: [1.001-1.7]; P = 0.049). Conclusions: When compared with ONU, RNU increased the odds of LND performance and had a lower inpatient complication rate, whereas LNU reduced the odds of LND performance and had no significant effect on inpatient complication rates. Performance of LND was independently associated with higher inpatient complication rates.

KW - Complications

KW - Lymph node excision

KW - Patterns of care

KW - Treatment outcome

KW - Upper urinary tract

KW - Urothelial carcinoma

UR - http://www.scopus.com/inward/record.url?scp=84958113184&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958113184&partnerID=8YFLogxK

U2 - 10.1016/j.urolonc.2015.09.008

DO - 10.1016/j.urolonc.2015.09.008

M3 - Article

C2 - 26493447

AN - SCOPUS:84958113184

VL - 34

SP - 121.e15-121.e21

JO - Urologic Oncology: Seminars and Original Investigations

JF - Urologic Oncology: Seminars and Original Investigations

SN - 1078-1439

IS - 3

ER -