title: Postoperative complications and long-term survival among patients treated surgically for renal cell carcinoma.
abstract: OBJECTIVE
  In addition to their acute implications, adverse events after oncological surgery may have late or long-term consequences for patient outcomes. We assessed the relationship between postoperative complications and long-term survival among patients treated surgically for kidney cancer.
  
  
  METHODS
  Using Surveillance, Epidemiology and End Results-Medicare data we identified patients with kidney cancer treated surgically from 1995 through 2005. After excluding from analysis those who died during the index hospitalization or within 30 days of surgery we compared overall survival for patients with or without a postoperative complication. We then fit multivariate Cox proportional hazard models to estimate the association between complications and long-term survival, adjusting for patient characteristics, cancer severity and surgical approach.
  
  
  RESULTS
  We identified 4,687 (37%) and 7,931 patients (63%) with and without a postoperative complication, respectively. During a median followup of 32 months (range 1 to 132) 3,425 patients (27.1%) died of any cause. Patients with at least 1 postoperative complication had lower unadjusted 5-year survival (59.9% vs 69.5%, p <0.001). On multivariate analyses the occurrence of a complication was also associated with significantly worse long-term survival (HR 1.24, 95% CI 1.16-1.33). This relationship was consistent with time, across surgical approaches and among patients with various specific complications, including acute renal failure, cardiac and neurological events, postoperative infection and sepsis.
  
  
  CONCLUSIONS
  The occurrence of a postoperative complication is associated with decreased long-term survival after surgery for kidney cancer. Clarification of the cascade of events underlying this relationship may lead to new strategies to improve outcomes among cancer survivors.
authors: Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-2800, USA.
authors: Hung-Jui
authors: HJ
authors: Tan
authors: Khaled S
authors: KS
authors: Hafez
authors: Zaojun
authors: Z
authors: Ye
authors: John T
authors: JT
authors: Wei
authors: David C
authors: DC
authors: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D015996:Survival Rate; D013997:Time Factors