title: Does mechanical bowel preparation improve quality of laparoscopic nephrectomy? Propensity score-matched analysis in Japanese series.
abstract: OBJECTIVE
  To assess the effect of mechanical bowel preparation (MBP) before laparoscopic nephrectomy in terms of operation time and perioperative complications.
  
  
  METHODS
  Patients undergoing laparoscopic nephrectomy for T1-T3 tumors were identified in the Japanese Diagnosis Procedure Combination database from 2008 to 2010. The patients were stratified into a preoperative MBP group (polyethylene glycol electrolyte, magnesium citrate solution, and sodium picosulfate) and a non-MBP group and were matched using one-to-one propensity score matching according to age, sex, Charlson score, T category, hospital volume, and hospital academic status. The operation time, postoperative length of stay, and overall complication rate were assessed by multivariate regression analyses.
  
  
  RESULTS
  Of 2740 patients in 355 hospitals, 1110 pairs were generated. The median operation time, postoperative stay, and overall complication rate (MBP vs non-MBP group) was 278 and 268 minutes (P<.004), 10.3 and 10.0 days (P=.695), and 11.8% and 11.4% (P=.740), respectively. The multivariate regression analyses did not find significant superiority of MBP for the 3 endpoints (all P>.05). A shorter operation time was significantly associated with female sex and early-stage tumor. Older age, greater Charlson score, and lower hospital volume adversely affected the postoperative stay and overall complication rate. Stage T3 tumor was unfavorable for the postoperative stay.
  
  
  CONCLUSIONS
  Our large-scale propensity score-matched analysis did not demonstrate a benefit for MBP in operation time, postoperative stay, or overall complications. The results suggest that MBP can be safely omitted before laparoscopic nephrectomy for T1-T3 tumors.
authors.affiliation: Department of Urology, Shintoshi Hospital, Iwata, Japan. ezy04707@nifty.com
authors.forename: Toru
authors.initials: T
authors.lastname: Sugihara
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fujimura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nishimatsu
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ohe
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D000367:Age Factors; D000368:Aged; D002400:Cathartics / Q000008:administration & dosage*; D002951:Citrates / Q000008:administration & dosage; D019343:Citric Acid / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007564:Japan; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000592:standards*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000592:standards*; D061646:Operative Time; D009942:Organometallic Compounds / Q000008:administration & dosage; D010847:Picolines / Q000008:administration & dosage; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011183:Postoperative Complications / Q000209:etiology; D057216:Propensity Score; D012737:Sex Factors; D018709:Statistics, Nonparametric
chemical_list: D002400:Cathartics; D002951:Citrates; D009942:Organometallic Compounds; D010847:Picolines; D019343:Citric Acid; D011092:Polyethylene Glycols; C005701:picosulfate sodium; C110422:magnesium citrate