Predictors of health-related quality of life recovery following laparoscopic simple, radical and donor nephrectomy.
OBJECTIVE
To objectively quantify the recovery of health-related quality of life (HRQL) in patients undergoing laparoscopic nephrectomy. To determine which factors are predictive of a more expedited recovery.


METHODS
Patient recovery was prospectively measured among patients undergoing laparoscopic simple (n= 12), radical (n= 42) and donor (n= 95) nephrectomy. All procedures were performed using a 3- or 4-trocar, transperitoneal fully-laparoscopic technique with intact specimen extraction using impermeable sacs for simple and radical nephrectomy, and hand extraction for donor nephrectomy. Postoperative recovery and quality of life were measured using the Postoperative Recovery Scale (PRS) administered preoperatively, immediately postoperatively and as an outpatient at 4, 8, 12, and 16 weeks postoperatively. ANOVA and Pearson's χ² tests were performed on demographic data. Multivariate logistic regression analysis was used to calculate odds ratios for factors predictive of recovery.


RESULTS
Statistically significant differences were found at baseline for age (P = 0.02), gender (P < 0.01), body mass index (BMI; P = 0.03), surgical side (P < 0.01) and activity-based lifestyle (P = 0.04) across the three groups. Minimal adverse events were seen. Factors predictive of expedited recovery include age < 50 years (OR: 2.1, P < 0.01), body-mass index (BMI) < 30 kg/m² (OR: 1.7, P < 0.01), active lifestyles (OR: 1.3, P < 0.01) and those patients undergoing nephrectomy for benign or malignant indications rather than for organ donation (OR: 1.4, P < 0.01). There was a significant delay in the donor group vs the non-donor group with respect to the median number of days both groups took to recover 75% and 90% of their baseline PRS scores (11 days, P = 0.02; 20 days, P = 0.02, respectively).


CONCLUSIONS
Predictive factors of recovery from laparoscopic nephrectomy include age, BMI, lifestyle and surgical indication. Differences between HRQL recovery following donor vs non-donor laparoscopic nephrectomy are significant, and suggest the possible interplay of underlying psychological factors.
Wiesenthal
Joshua D
JD
Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Schuler
Trevor D
TD
Honey
R John D'A
RJ
Pace
Kenneth T
KT
D000328:Adult; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000534:rehabilitation* / Q000601:surgery; D016030:Kidney Transplantation; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods / Q000534:rehabilitation*; D011788:Quality of Life; D016896:Treatment Outcome