Mortality, morbidity and healthcare expenditures after local tumour ablation or partial nephrectomy for T1A kidney cancer.
BACKGROUND
Local tumour ablation (LTA) may yield better perioperative outcomes than partial nephrectomy (PN), however the impact of each treatment on perioperative mortality and health care expenditures is unknown. The aim of the study was to compare mortality, morbidity and health care expenditures between LTA and PN.


METHODS
A population-based assessment of 2471 patients with cT1a kidney cancer treated with either LTA or PN, between 2000 and 2009, in the SEER-Medicare database was performed. After propensity score matching, 30-day mortality, overall and specific complication rates, length of stay, readmission rates and health care expenditures according to LTA or PN were estimated. Multivariable logistic and linear models addressed the effect of each specific LTA approach on overall complication rates, length of stay, readmission rates and health care expenditures.


RESULTS
The 30-day mortality was <2% after either LTA or PN (OR 2.27, p = 0.2). The overall complication rate was 21% after LTA and 40% after PN (OR 0.38, p < 0.001). Blood transfusions, infection/sepsis, wound infections, respiratory complications, gastrointestinal complications, acute kidney injury, and accidental puncture or laceration/foreign body left during procedure rates resulted lower after LTA relative to PN (all p < 0.05). Similarly, length of stay and health care expenditures resulted lower after LTA relative to PN (all p < 0.05). Conversely, readmission rate was not significantly different in LTA relative to PN (p = 0.1).


CONCLUSIONS
Despite similar perioperative mortality, LTA is associated with lower complications rate, shorter length of stay and lower health care expenditure relative to PN.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: alelarcher@gmail.com.
A
A
Larcher
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
M
M
Sun
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
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P
Dell'Oglio
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.
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V
Trudeau
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
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K
Boehm
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
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J
Schiffmann
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
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Z
Tian
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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N
Fossati
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
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U
Capitanio
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
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A
Briganti
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
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F
Montorsi
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.
P
P
Karakiewicz
D058186:Acute Kidney Injury / Q000191:economics / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D002292:Carcinoma, Renal Cell / Q000191:economics / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007049:Iatrogenic Disease / Q000191:economics / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000191:economics / Q000601:surgery*; D010535:Laparoscopy; D007813:Laparotomy; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D006278:Medicare; D009026:Mortality; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D057216:Propensity Score; D012140:Respiratory Tract Diseases / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D018426:SEER Program; D018805:Sepsis / Q000191:economics / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
Complications; Health care expenditure; Kidney cancer; Local tumour ablation; Nephron sparing surgery; Partial nephrectomy; Perioperative mortality