title: Trends and perioperative outcomes for laparoscopic and robotic nephrectomy using the National Surgical Quality Improvement Program (NSQIP) database.
abstract: OBJECTIVE
  We sought to examine the trends in perioperative outcomes of kidney cancer surgery stratified by type (radical nephrectomy [RN] vs. partial nephrectomy [PN]) and approach (open vs. minimally invasive).
  
  
  METHODS
  We queried the National Surgical Quality Improvement Program database to identify kidney cancer operations performed from 2005 to 2011. We examined 30-day perioperative outcomes including operative time, transfusion rate, length of stay, major morbidity (cardiovascular, pulmonary, renal, and infectious), and mortality.
  
  
  RESULTS
  A total of 2,902 PN and 5,459 RN cases were identified. The use of PN increased over time, accounting for 39% of all nephrectomies in 2011. Minimally invasive approaches also increased over time for both RN and PN. Open surgery was associated with increased length of stay, receipt of transfusion, major complications, and perioperative mortality. Resident involvement and open approach were independent predictors of major complications for both PN and RN. Additionally, the presence of a medical comorbidity was also a risk factor for complications after RN. The overall complication rates decreased for all approaches over the study period.
  
  
  CONCLUSIONS
  Minimally invasive approaches to kidney cancer renal surgery have increased with favorable outcomes. The safety of open and minimally invasive PN improved significantly over the study period. Although pathologic features cannot be determined from this data set, these data show that complications from renal surgical procedures are decreasing in an era of increasing use.
authors: James Buchanan Brady Urologic Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: jenliu@jhmi.edu.
authors: Jen-Jane
authors: JJ
authors: Liu
authors: Department of Urology, Stanford University School of Medicine, Stanford, CA.
authors: John T
authors: JT
authors: Leppert
authors: Department of Anesthesia, Stanford University School of Medicine, Stanford, CA.
authors: Bryan G
authors: BG
authors: Maxwell
authors: Department of Anesthesia, Stanford University School of Medicine, Stanford, CA.
authors: Periklis
authors: P
authors: Panousis
authors: Department of Urology, Stanford University School of Medicine, Stanford, CA.
authors: Benjamin I
authors: BI
authors: Chung
mesh_terms: D015331:Cohort Studies; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000639:trends*; D019990:Perioperative Care; D011379:Prognosis; D058996:Quality Improvement; D012371:Robotics / Q000639:trends*
keywords: Laparoscopic nephrectomy; Nephron-sparing surgery; Robotic nephrectomy