title: The effect of age on the morbidity of kidney surgery.
abstract: OBJECTIVE
  Previous reports of the morbidity of renal surgery have been primarily from academic tertiary referral centers and, thus, they may not reflect general clinical practice. We determined the effect of age and comorbidity on in-hospital surgical morbidity for radical and partial nephrectomy on a population level.
  
  
  METHODS
  Data were obtained from a Canadian national discharge abstract database. From April 1998 to March 2008 information was available on 20,286 radical and 4,292 partial nephrectomies. Complications were identified using specific ICD-9 and 10 diagnosis and procedure codes. Complication rates were estimated by procedure type and by various explanatory variables, including patient age and Charlson comorbidity score. Multivariate logistic regressions were constructed for radical and partial nephrectomy to determine associations between explanatory variables and complications.
  
  
  RESULTS
  Overall complications developed in 34.1% of radical and 34.3% of partial nephrectomy cases. Patients were more likely to have cardiac, respiratory, vascular and surgical complications after radical nephrectomy while they were more likely to experience genitourinary and nephrectomy specific complications after partial nephrectomy. On multivariate logistic regression after radical and partial nephrectomy complications increased with age and Charlson score. After adjusting for other covariates patients with a Charlson score of greater than 2 were approximately 6 times more likely to experience a complication than patients with a Charlson score of 0 for radical and partial nephrectomy (OR 6.22, 95% CI 5.18-7.48 and OR 5.68, 95% CI 3.72-8.66, respectively).
  
  
  CONCLUSIONS
  In our population based study radical nephrectomy and partial nephrectomy were associated with higher morbidity than previously reported, particularly in the elderly population and in patients with comorbidity.
authors.affiliation: Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106, USA. robert.abouassaly@UHhospitals.org
authors.forename: Robert
authors.initials: R
authors.lastname: Abouassaly
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
authors.forename: George A
authors.initials: GA
authors.lastname: Tomlinson
authors.forename: David R
authors.initials: DR
authors.lastname: Urbach
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D055815:Young Adult