title: Predictive factors of hemorrhagic complications after partial nephrectomy.
abstract: OBJECTIVE
  To identify the predictive factors of hemorrhagic complications (HC) in a contemporary cohort of patients who underwent partial nephrectomy (PN).
  
  
  METHODS
  Records of 199 consecutive patients who underwent PN between 2008 and 2012 at our institution were retrospectively analyzed. HC was defined as a hematoma requiring transfusion, an arterio-veinous fistula, a false aneurysm or a post-operative decrease of hemoglobin >3 g/dl. Patients with or without HC were compared using Wilcoxon and Fisher exact tests for continuous and categorical variables, respectively. We performed a univariate and multivariate analysis with a logistic regression model using the occurrence of an HC as the dependent variable.
  
  
  RESULTS
  54% of the patients were male with a median age of 61 (22-86) years. Median BMI was 26 (18-47) kg/m(2). Surgery was done open, laparoscopically or with robotic assistance in 106, 54 and 39 cases, respectively. Global complication rate was 40% including 21.6% HC. There were more complex tumors (75.6% vs. 66.5%, p = 0.04) and median length of stay was increased (11 days compared to 7 days, p < 0.0001) in case of a HC. In univariate analysis, imperative indication (p = 0.08), RENAL score (p = 0.07), operating time (p = 0.07) and operative blood loss > 250 ml (p = 0.002) were statistically relevant. In multivariate analysis, only operative blood loss >250 ml was identified as a predictive factor of HC (p = 0.0007).
  
  
  CONCLUSIONS
  Patients who underwent a procedure with estimated blood loss >250 ml should be carefully monitored in the postoperative course.
authors.affiliation: Department of Urology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033 Rennes Cedex, France. Electronic address: tfardoun@gmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Fardoun
authors.affiliation: Department of Urology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033 Rennes Cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Chaste
authors.affiliation: Department of Biostatistics, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033 Rennes Cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Oger
authors.affiliation: Department of Urology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033 Rennes Cedex, France.
authors.forename: R
authors.initials: R
authors.lastname: Mathieu
authors.affiliation: Department of Urology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033 Rennes Cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Department of Pathology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033 Rennes Cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Rioux-Leclercq
authors.affiliation: Department of Urology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033 Rennes Cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Verhoest
authors.affiliation: Department of Urology, Bicetre University Hospital, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France.
authors.forename: J J
authors.initials: JJ
authors.lastname: Patard
authors.affiliation: Department of Urology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033 Rennes Cedex, France.
authors.forename: K
authors.initials: K
authors.lastname: Bensalah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: Complications; HC; Hemorrhage; MDRD; NSS; PN; Partial nephrectomy; RCC; RENAL Score; RENAL score; RN; RS; hemorrhagic complication; modification of diet in renal disease; nephron sparing surgery; partial nephrectomy; radical nephrectomy; renal cell carcinoma