title: Results of a national population-based study of outcomes of surgery for renal tumors associated with inferior vena cava thrombus.
abstract: OBJECTIVE
  To determine whether surgeon or hospital volume effects in-hospital mortality or complications of radical nephrectomy with concomitant removal of inferior vena cava (IVC) thrombus, we examine a national population-based cohort. Radical nephrectomy with removal of IVC thrombus is a complex urologic operation, which, similar to other major surgical procedures, may have an association between provider volume and outcomes.
  
  
  METHODS
  Canadian Institute for Health Information administrative codes were used to identify nephrectomies associated with IVC manipulation in Canada from 1998 to 2007. Canadian Institute for Health Information databases yielded information on in-hospital mortality and complications for the hospital admission at surgery. Multivariate regression analysis was performed to assess the effect of surgeon and hospital volume on in-hospital mortality and complications, adjusting for age, sex, comorbidity, year of surgery, and region.
  
  
  RESULTS
  During the study period, 816 radical nephrectomies with associated IVC thrombectomy were performed on 521 men and 295 women. The in-hospital mortality rate was 7%. Notably, 75% of deaths occurred in the first 2 cases of surgeon experience. Median length of stay was 10 days. Complications were noted in 633 patients (78%). Fifty-eight patients with concomitant cardiac bypass had increased in-hospital mortality and complications. Age, comorbidity, and cardiac bypass were the strongest predictors of in-hospital mortality. Increasing surgeon volume, but not hospital volume, was associated with lower in-hospital mortality on multivariate regression analysis; however, this was not statistically significant.
  
  
  CONCLUSIONS
  Radical nephrectomy with associated IVC thrombectomy has significant complications and mortality. Surgeon but not hospital volume may affect outcomes.
authors.affiliation: Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Toren
authors.forename: Robert
authors.initials: R
authors.lastname: Abouassaly
authors.forename: Narhari
authors.initials: N
authors.lastname: Timilshina
authors.forename: Girish
authors.initials: G
authors.lastname: Kulkarni
authors.forename: Shabbir
authors.initials: S
authors.lastname: Alibhai
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
mesh_terms: D000367:Age Factors; D002170:Canada / Q000453:epidemiology; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000601:surgery*; D002983:Clinical Competence / Q000706:statistics & numerical data; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D017131:Thrombectomy / Q000009:adverse effects / Q000401:mortality*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000150:complications / Q000601:surgery*