title: Predictors of Medical and Surgical Complications After Robot-Assisted Partial Nephrectomy: An Analysis of 1139 Patients in a Multi-Institutional Kidney Cancer Database.
abstract: Previous robot-assisted partial nephrectomy (RAPN) studies have identified various predictors of overall and major postoperative complications, but few have evaluated the specific role of these factors in the development of medical and surgical complications. In this study, we present an analysis of the modifiable and nonmodifiable variables influencing medical and surgical complications in a contemporary series of patients who underwent RAPN and were followed in a prospectively maintained, multi-institutional kidney cancer database.
  
  
  
  A retrospective review of all patients who underwent RAPN at four institutions between 2008 and 2015 was performed. Multivariable logistic regression models were used to determine predictors of medical and surgical postoperative complications.
  
  
  
  Data from 1139 patients were available for analysis. Sixty-seven patients (5.8%) experienced a medical postoperative complication, and 82 (7.1%) experienced a surgical complication. Decreasing baseline estimated glomerular filtration rate (eGFR) (odds ratio [OR] = 0.98, p = 0.003), greater estimated blood loss (EBL) (OR = 1.002, p = 0.001), and operating surgeon (OR = 8.01, p < 0.001) were associated with an increased likelihood of surgical complications, while decreasing baseline eGFR (OR = 0.99, p = 0.054) and operating surgeon (OR = 1.96, p = 0.054) were associated with an increased likelihood of medical complications.
  
  
  
  We present complication risks in a large contemporary cohort of patients undergoing robotic partial nephrectomy (RPN) with only 11.3% of patients experiencing a medical or surgical postoperative complication. Prospective candidates for robotic PN with poor baseline renal function and/or risk factors for greater EBL, including a high body mass index, or a complex renal mass should be counseled appropriately on their increased risk for a medical or surgical postoperative complication.
authors: 1 Department of Urology, Icahn School of Medicine at Mount Sinai , New York, New York.
authors: Eric J
authors: EJ
authors: Moskowitz
authors: 1 Department of Urology, Icahn School of Medicine at Mount Sinai , New York, New York.
authors: David J
authors: DJ
authors: Paulucci
authors: 1 Department of Urology, Icahn School of Medicine at Mount Sinai , New York, New York.
authors: Balaji N
authors: BN
authors: Reddy
authors: 1 Department of Urology, Icahn School of Medicine at Mount Sinai , New York, New York.
authors: Kyle A
authors: KA
authors: Blum
authors: 1 Department of Urology, Icahn School of Medicine at Mount Sinai , New York, New York.
authors: Daniel C
authors: DC
authors: Rosen
authors: 2 OhioHealth Dublin Methodist Hospital , Columbus, Ohio.
authors: Ronney
authors: R
authors: Abaza
authors: 3 Temple University School of Medicine , Philadelphia, Pennsylvania.
authors: Daniel D
authors: DD
authors: Eun
authors: 4 Wake Forest School of Medicine , Winston-Salem, North Carolina.
authors: Ashok K
authors: AK
authors: Hemal
authors: 4 Wake Forest School of Medicine , Winston-Salem, North Carolina.
authors: Louis S
authors: LS
authors: Krane
authors: 1 Department of Urology, Icahn School of Medicine at Mount Sinai , New York, New York.
authors: Ketan K
authors: KK
authors: Badani
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects*
keywords: complications; renal cancer; robotics