title: Mortality and morbidity after cytoreductive nephrectomy for metastatic renal cell carcinoma: a population-based study.
abstract: OBJECTIVE
  To test whether the rates of in-hospital mortality, complications, and transfusions are higher in patients treated with cytoreductive nephrectomy (CNT) for metastatic renal cell carcinoma (mRCC) relative to patients treated with nephrectomy (NT) for non-mRCC.
  
  
  METHODS
  We assessed 17,688 patients treated with a NT between years 1999 and 2008, within the Florida Inpatient Database. Chi-square and Student t-tests were used to compare the statistical significance of differences in proportions and means, respectively. Univariable and multivariable logistic regression analyses tested the relationship between surgery type (CNT vs. NT) and three end points: in-hospital mortality, complications, and transfusions.
  
  
  RESULTS
  Overall, 6.0% of patients underwent CNT. The rates of in-hospital mortality, complications, and transfusions were 2.4, 26.5, and 24.3% in CNT patients versus 0.9, 18.9, and 11.1% in NT patients. At multivariable analyses, CNT patients demonstrated a 2.0-, 1.3-, and 2.4-fold higher risk of in-hospital mortality, complications, and transfusions (all P < 0.001). Similarly, more advanced age, comorbidity, and the cumulative number of secondary surgical procedures were independent predictors of a higher risk of in-hospital mortality, complications, and transfusions (all P < 0.001).
  
  
  CONCLUSIONS
  The rate of in-hospital mortality, complications, and transfusions is higher in patients treated with CNT relative to NT. Older age, higher comorbidity, and the necessity of secondary surgical procedures further increases the risk of all aforementioned end points. Physicians should consider these observations during the planning of a CNT, and patients should be informed accordingly.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada. firas.abdollah@gmail.com
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thuret
authors.forename: Jan
authors.initials: J
authors.lastname: Schmitges
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
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; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009392:Nephrectomy / Q000401:mortality*; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate