title: Open renal biopsy: comorbidities and complications in a contemporary series.
abstract: METHODS
  Therapy (case series) Level of Evidence 4.
  
  
  OBJECTIVE
  To report the indications and outcomes of a contemporary series of patients with contraindications to percutaneous renal biopsies (PRBs) who had an operative RB (ORB), as although ORB is a relatively infrequent procedure, it remains an important and underreported operation.
  
  
  METHODS
  In a retrospective review of patients who had an ORB we examined comorbidities, indications, and 30-day morbidity and mortality. Preoperative comorbidities were stratified according to the Charlson comorbidity index.
  
  
  RESULTS
  In all, 115 patients had ORB between 1991 and 2006 (mean age 48 years, range 18-83); 60% of the patients were American Society of Anesthesiologists class >or=3. The median Charlson comorbidity index score was 3, with a score of 0 in 20.9%, 1-2 in 27.8%, 3-4 in 30.4% and >or=5 in 20.9% of patients. Indications for an ORB included morbid obesity, failed PRB, coagulopathy, and solitary kidney. In all, 47.8% of patients had a serum creatinine level of <3.0 mg/dL, 34.8% of >3.0 mg/dL and 17.4% were dialysis-dependent. There were 43 complications in 36 patients. The mortality rate after surgery was 0.8%. There were eight major complications in seven patients (6.1%) including cardiac arrest, stroke, sepsis, reoperation and re-intubation. There were minor complications 34 times in 31 patients (27%), the most common being wound infection, pneumonia, intraoperative transfusion of >2 units, arrhythmia, postoperative retroperitoneal bleed, and seep vein thrombosis.
  
  
  CONCLUSIONS
  This study shows that there are significant comorbidities in patients referred to urologists for an ORB. With a mortality rate of 0.8% and major and minor complication rates of 6.1% and 27%, respectively, the ORB, while infrequent, carries a significant risk in this population that should be included in preoperative decision making and used for patient counselling.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-2765, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Stec
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Stratton
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Kaufman
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Milam
authors.forename: S Duke
authors.initials: SD
authors.lastname: Herrell
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult