title: In-hospital mortality and failure to rescue after cytoreductive nephrectomy.
abstract: BACKGROUND
  The risk of in-hospital mortality after cytoreductive nephrectomy (CNT) is non-negligible and may vary widely according to various patient and hospital characteristics and clinical contexts.
  
  
  OBJECTIVE
  To better elucidate the mechanisms underlying variability in operative mortality after CNT.
  
  
  METHODS
  Using the US-based Nationwide Inpatient Sample registry, a weighted estimate of 16 285 patients with metastatic renal cell carcinoma (mRCC) treated with CNT between 1998 and 2007 was made retrospectively.
  
  
  METHODS
  Failure to rescue (FTR), defined as the number of deaths in patients who developed an adverse outcome during hospitalization. Univariable and multivariable logistic regression models were used.
  
  
  RESULTS
  Of all 16 285 mRCC patients who underwent a CNT, 31% had an occurrence of one complication or more. The overall FTR rate was 5% and differed significantly according to age (≥ 75 yr vs <75 yr: 7.9% vs 4.3%) and comorbidities (≥ 3 vs 0: 7.7% vs 4.8%), as well as hospital bed size (small vs large: 7.2% vs 5.3%, all p ≤ 0.03). Patients who had an occurrence of infections (19.3%), cardiac- (15.7%), respiratory- (11.4%), or vascular-related complications (16.5%) had significantly higher FTR rates. It is noteworthy that increasing hospital volume and number of hospital beds also corresponded to lower rates of FTR after adjusting for other covariates.
  
  
  CONCLUSIONS
  Following CNT for mRCC, the occurrence of infections, cardiac-, respiratory-, or vascular-related complications resulted in higher FTR rates. Hospitals with greater number of beds and higher annual hospital volume had lower FTR rates, confirming the concepts that support FTR as an indicator for better quality of care following a high-risk surgical procedure.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Jens
authors.initials: J
authors.lastname: Hansen
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006742:Hospital Bed Capacity; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies