Background: The purpose of this study is to characterize and compare shorttermcomplications following laparoscopic radical nephrectomy (RN) andlaparoscopic nephroureterectomy (NU). Although there have been studieslooking at each of these procedures separately, very few have comparedshort term morbidity between the two, given their similar anatomical andtechnical considerations.Methods: We conducted a historical cohort , looking at patients undergoinglaparoscopic RN or laparoscopic NU from 2006-2012. Baseline informationand short term 30-day postoperative data was collected from The NationalSurgical Quality Improvement Program (NSQIP) database by trained studynurses through medical record reviews and direct patient contacts (interrateraccuracy was greater than 95%). The associations between patientand surgical factors with short term surgical outcomes were then verified bycalculating relative risks and by using univariate and multivariable models.Results: During the study period, 4904 patients met the inclusion criteria.Of these patients, 4159 (85%) received a laparoscopic RN while 745(15%) received a laparoscopic NU. Overall, 651 (13%) experienced atleast one short-term postoperative complication; of these, laparoscopicNU was associated with more complications than laparoscopic RN (21%and 13%, respectively). The most common complications overall were:bleeding requiring blood transfusions in 318 (6.5%), urinary tract infectionsin 97 (2.0%), wound infections in 85 (1.7%), unplanned intubations in 56(1.1%), and pneumonia in 45 (0.9%). After adjusting for possible confounders,increased patient age (RR 1.01, 95% CI 1.01-1.02), ASA classification3 (RR 1.34, 95% CI 1.10-1.63), higher preoperative creatinine (RR 1.11,95% CI 1.06-1.17), bleeding requiring 4 units of blood within 72 hourspreoperatively (RR 1.93, 95% CI 1.29-2.86), operative time 6 hours (RR2.17, 95% CI 1.71-2.75), and laparoscopic NU versus RN (RR 1.41, 95%CI 1.16-1.72) were each independently associated with having at least onepostoperative complication.Conclusions: Postoperative complications within 30 days are common afterlaparoscopic NU and laparoscopic RN. Despite having technical similarities,laparoscopic NU carries a significantly higher risk of developing shortterm complications than laparoscopic RN. Knowing baseline patient andsurgical factors that predispose patients to complications, along with whatthese complications are, allows for clinicians to better counsel their patientson what to expect during the short term postoperative period.
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