title: Predictors of Postoperative Complications in Patients Who Undergo Radical Nephrectomy and IVC Thrombectomy: A Large Contemporary Tertiary Center Analysis.
abstract: In an analysis of a large single-institution experience in the surgical management of renal cell carcinoma (RCC) and inferior vena cava (IVC) thrombus, the authors present the effect of RCC characteristics on survival, and aim to identify potential preoperative variables predictive of intraoperative complexity with regard to estimated blood loss, transfusion volume, surgical time, length of stay, and postoperative complication rates. Age, American Society of Anesthesiologists score, Charlson Comorbidity Index, preoperative calcium, preoperative creatinine, and IVC wall invasion were significantly related to complication rates.
  
  
  BACKGROUND
  Preoperative laboratory values are commonly used as markers of health and potential disease burden, however, their effect on perioperative complexity has not previously been assessed. The authors aimed to evaluate the effect of renal cell carcinoma and inferior vena cava (IVC) thrombus characteristics on cancer-specific survival (CSS), and identify potential preoperative variables predictive of intraoperative complexity.
  
  
  METHODS
  In a retrospective chart review we identified 144 patients who underwent nephrectomy and IVC thrombectomy. Univariate and multivariate analyses were used to assess the effect of disease characteristics on CSS and postoperative complications. Linear regression analysis was used to determine the association between preoperative laboratory values and intraoperative complexity characterized by estimated blood loss (EBL), transfusion volume (TV), operative time, and length of hospital stay (LOS).
  
  
  RESULTS
  Analysis of intraoperative complexity revealed a significant correlation between preoperative creatinine (Cr) and EBL (P = .022), TV (P = .041), and LOS (P = .005), and preoperative hemoglobin (Hgb) was associated with increased EBL (P < .001) and TV (P < .001). Multivariate analyses showed a significant relationship between overall complication rates and preoperative calcium (Ca; P = .012), American Society of Anesthesiologists (ASA) score (P = .003), and IVC wall invasion (P = .005), and a significant association between major complications and preoperative Ca (P = .011), preoperative Cr (P = .041), age (P = .050), and Charlson Comorbidity Index (CCI; P = .002).
  
  
  CONCLUSIONS
  With regard to intraoperative complexity and postoperative complications, preoperative Cr and Hgb were significantly associated with increased EBL, TV, and LOS, and ASA score, preoperative Ca, preoperative Cr, IVC wall invasion, age, and CCI were found to have significant relationships with complication rates.
authors.affiliation: University of South Florida Morsani College of Medicine, Tampa, FL.
authors.forename: Kathy
authors.initials: K
authors.lastname: Lue
authors.affiliation: University of South Florida Morsani College of Medicine, Tampa, FL.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Russell
authors.affiliation: University of South Florida Morsani College of Medicine, Tampa, FL.
authors.forename: John
authors.initials: J
authors.lastname: Fisher
authors.affiliation: University of South Florida Morsani College of Medicine, Tampa, FL.
authors.forename: Tony
authors.initials: T
authors.lastname: Kurian
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Gautum
authors.initials: G
authors.lastname: Agarwal
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Adam
authors.initials: A
authors.lastname: Luchey
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Michael
authors.initials: M
authors.lastname: Poch
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Julio M
authors.initials: JM
authors.lastname: Pow-Sang
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Wade J
authors.initials: WJ
authors.lastname: Sexton
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, FL. Electronic address: philippe.spiess@moffitt.org.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D017131:Thrombectomy / Q000009:adverse effects*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery
keywords: Kidney; Renal cell; Thrombus; carcinoma