title: Propensity-score matched comparison of complications, blood transfusions, length of stay, and in-hospital mortality between open and laparoscopic partial nephrectomy: a national series.
abstract: BACKGROUND
  To examine the use of open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN), as well as intraoperative and postoperative morbidity.
  
  
  METHODS
  A retrospective cohort analysis of the Nationwide Inpatient Sample for years 1998-2007. Patients with non-metastatic kidney cancer who underwent OPN or LPN were identified. Propensity-based matching was performed to adjust for potential baseline differences between the two groups. The rates of intraoperative and postoperative complications, blood transfusions, length of stay, and in-hospital mortality were assessed for both procedures.
  
  
  RESULTS
  Overall, 7990 (93.9%) and 523 (6.1%) patients underwent OPN and LPN, respectively. Use of LPN increased 19-fold over the study period (P < 0.001). For OPN and LPN respectively, the following rates were recorded: blood transfusions, 9.3 vs. 3.8% (P < 0.001); intraoperative complications, 2.9 vs. 1.5% (P = 0.06); postoperative complications, 15.4 vs. 11.3% (P = 0.01); length of stay ≥5 days, 46.7 vs. 20.8% (P < 0.001); in-hospital mortality, 0.4 vs. 0.4% (P = 0.98). In multivariable logistic regression analyses, LPN patients were less likely to have a blood transfusion (odds ratio [OR]: 0.40, P < 0.001), to experience any postoperative complication (OR: 0.74, P = 0.03), and to be hospitalized for more than 5 days (OR: 0.32, P < 0.001). Post-propensity score matched analyses revealed virtually the same results.
  
  
  CONCLUSIONS
  After adjustment for potential selection biases, LPN is associated with fewer adverse outcomes than OPN. However, the current results should be interpreted with caution, given the lack of tumor characteristics. Furthermore, statistical adjustment is not a substitute for a needed randomized trial.
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Hospital St-Luc, 1058, rue St-Denis, Montreal, Quebec, Canada H2X 3J4. mcw.sun@umontreal.ca
authors: M
authors: M
authors: Sun
authors: F
authors: F
authors: Abdollah
authors: S F
authors: SF
authors: Shariat
authors: J
authors: J
authors: Schmitges
authors: Q-D
authors: QD
authors: Trinh
authors: Z
authors: Z
authors: Tian
authors: C
authors: C
authors: Jeldres
authors: A
authors: A
authors: Abdo
authors: M
authors: M
authors: Bianchi
authors: A
authors: A
authors: Briganti
authors: F
authors: F
authors: Montorsi
authors: P
authors: P
authors: Perrotte
authors: P I
authors: PI
authors: Karakiewicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015982:Bias; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007432:Intraoperative Period; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011184:Postoperative Period; D012107:Research Design; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology