title: Thirty-day mortality after nephrectomy: clinical implications for informed consent.
abstract: BACKGROUND
  The existing literature suggests that the surgical mortality (SM) observed with nephrectomy for localised disease varies from 0.6% to 3.6%.
  
  
  OBJECTIVE
  To examine age- and stage-specific 30-d mortality (TDM) rates after partial or radical nephrectomy.
  
  
  METHODS
  We relied on 24535 assessable patients from the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) database.
  
  
  METHODS
  In 12283 patients, logistic regression models were used to develop a tool for pretreatment prediction of the probability of TDM according to individual patient and tumour characteristics. External validation was performed on 12252 patients.
  
  
  CONCLUSIONS
  In the entire cohort of 24535 patients, 219 deaths occurred during the initial 30 d after nephrectomy (0.9% TDM rate). TDM increased with age (≤49 yr: 0.5% vs 50-59 yr: 0.7% vs 60-69 yr: 0.9% vs 70-79 yr: 1.2% vs ≥80 yr: 2.0%; χ(2) trend p<0.001) and stage (0.3% for T1-2N0M0 vs 1.3% for T3-4N0-2M0 vs 4.2% for T1-4N0-2M1; χ2 trend p=<0.001). TDM decreased in more recent years (1988-1993: 1.3% vs 1994-1998: 0.9% vs 1999-2002: 0.7% vs 2003-2004: 0.6%; χ2 trend p<0.001) and was lower after partial versus radical nephrectomy (RN) (0.4% vs 0.9%; p=0.008). Only age (p<0.001) and stage (p<0.001) achieved independent predictor status. The look-up table that relied on the regression coefficients of age and stage reached 79.4% accuracy in the external validation cohort.
  
  
  CONCLUSIONS
  Age and stage are the foremost determinants of TDM after nephrectomy. Our model provides individual probabilities of TDM after nephrectomy, and its use should be highly encouraged during informed consent prior to planned nephrectomy.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Department of Urology, University of Montreal, Montreal, Québec, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Cloutier
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Laurent
authors.initials: L
authors.lastname: Zini
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Philippe
authors.initials: P
authors.lastname: Arjane
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000592:standards*; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000401:mortality*; D011237:Predictive Value of Tests; D012307:Risk Factors; D018426:SEER Program / Q000706:statistics & numerical data*; D013997:Time Factors