title: Laparoscopic nephroureterectomy is associated with higher risk of adverse events compared to laparoscopic radical nephrectomy.
abstract: BACKGROUND
  Laparoscopic radical nephrectomy (LRN) and laparoscopic nephroureterectomy (LNU) are similar procedures and some surgeons may believe the perioperative risks are the same. The purpose of this study is to characterize and compare complications following LRN and LNU.
  
  
  METHODS
  A historical cohort of patients who received either LRN or LNU between 2006 and 2012 was reviewed from the National Surgical Quality Improvement Program (NSQIP) database. Patient characteristics, surgical characteristics, and perioperative outcomes up to 30 days postoperatively were abstracted. Unadjusted and adjusted associations between procedure (LRN or LNU) and any adverse event were determined.
  
  
  RESULTS
  During the study period, 4904 patients met study inclusion criteria; 4159 (84.8%) received a LRN while 745 (15.2%) received a LNU. Overall, 651 (13.3%) patients experienced at least one postoperative complication. LNU was associated with more complications than LRN (21% and 12%, respectively, p value <0.01). The most common complications were: bleeding requiring blood transfusion (9.0% LNU vs. 6.0% LRN), urinary tract infection (4.6% LNU vs. 1.5% LRN), wound infection (1.3% LNU vs. 1.8% LRN), and unplanned intubation (2.3% LNU vs. 0.9% LRN). After adjusting for potential confounders, LNU was associated with higher risk of any complication compared to LRN (relative risk [RR] 1.41, 95% confidence interval [CI] 1.16-1.72). Other variables independently associated with an increased risk of complications included: increasing patient age (RR 1.01, 95% CI 1.01-1.02), American Society of Anesthesiologists (ASA) classification ≥3 (RR 1.34, 95% CI 1.10-1.63), higher preoperative creatinine (RR 1.11, 95% CI 1.06-1.17), >4 units of blood transfused within 72 hours before surgery (RR 1.93, 95% CI 1.29-2.86), and operative time >6 hours (RR 2.17, 95% CI 1.71-2.75).
  
  
  CONCLUSIONS
  Postoperative complications within 30 days of surgery are common after LNU and LRN. Despite having technical similarities, LNU carries a significantly higher risk of developing short-term complications compared to LRN. This information should be considered when counseling patients prior to surgery. Notable limitations of this study included the lack of information on tumour stage and management of the distal ureter.
authors.affiliation: Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;
authors.forename: Ravin
authors.initials: R
authors.lastname: Bastiampillai
authors.affiliation: Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada;
authors.forename: Luke T
authors.initials: LT
authors.lastname: Lavallée
authors.affiliation: Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada;
authors.forename: Sonya
authors.initials: S
authors.lastname: Cnossen
authors.affiliation: Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada;
authors.forename: Kelsey
authors.initials: K
authors.lastname: Witiuk
authors.affiliation: Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada;
authors.forename: Ranjeeta
authors.initials: R
authors.lastname: Mallick
authors.affiliation: Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada;
authors.forename: Dean
authors.initials: D
authors.lastname: Fergusson
authors.affiliation: Division of Otolaryngology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Schramm
authors.affiliation: Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;
authors.forename: Christopher
authors.initials: C
authors.lastname: Morash
authors.affiliation: Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;
authors.forename: Ilias
authors.initials: I
authors.lastname: Cagiannos
authors.affiliation: Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada;
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Breau