[Nephrectomy in denmark 2002-2005].
BACKGROUND
Implementation of principles of fast-track surgery as well as laparoscopy may decrease hospital stay after nephrectomy to about 2-4 days. The aim of this study was to analyse the incidence, use of laparoscopic vs. open nephrectomy, hospital stay, morbidity and mortality in Danish hospitals within the period 2002-2005.


METHODS
Extraction of information from the National Patient Register (LPR) and discharge notes from Jan. 1 2002 to Dec. 31 2004.


RESULTS
In the 3-year period, 1968 nephrectomies were performed in a total of 45 departments, decreasing to 29 departments in 2004. Five departments performed > 100 operations during the 3 years, 10 departments performed between 50-100 operations and 30 departments <50 operations during the 3 years. The average length of hospital stay (primary and readmission) was 9.1 days. The total mortality rate was 2.2%; lower (1.5%) in departments with high activity vs. departments with low activity (4.3%, p < 0.01). Laparoscopic surgery was performed in 11 departments with a hospital stay of 5.2 vs. 9.5 days and with fewer surgical and medical complications and mortality (0.4% vs. 2.5%), compared with open operation.


CONCLUSIONS
The organisation and results after nephrectomy are not optimal on a nationwide basis. This precludes further optimisation of the early perioperative results, including use of the laparoscopic approach combined with the principles of fast-track surgery. It is suggested that nephrectomy in the future is performed in fewer departments to fulfil these needs.
Firoozfard
Behroz
B
Sundhedsstyrelsen, Center for Evaluering og Medicinsk Teknologivurdering (CEMTV), H:S Rigshospitalet, Urologisk Afdeling, København S.
Christensen
Tom H
TH
Bendixen
Anette
A
Nordling
Jørgen
J
Kehlet
Henrik
H
D003718:Denmark / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality; D012042:Registries; D013503:Surgery Department, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data