Friedman Amy L, Cheung Kevin, Roman Sanziana A, Sosa Julie Ann
Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
Arch Surg. 2010 Apr;145(4):356-62; discussion 362. doi: 10.1001/archsurg.2010.17.
Efforts to maximize kidney transplantation are tempered by concern for the live donor's safety. Case series and center surveys exist, but national aggregate data are lacking. We sought to determine predictors of early clinical and economic outcomes following living donor nephrectomy.
A retrospective cross-sectional analysis using 1999-2005 discharge data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample was performed. Cases were identified by International Classification of Diseases, Ninth Revision (ICD-9), codes. Clinical and economic outcomes were analyzed with regard to patient and provider characteristics using bivariate and multivariate regression analyses.
Healthcare Cost and Utilization Project Nationwide Inpatient Sample.
Patients undergoing living donor nephrectomy, identified by the ICD-9 codes.
Clinical and economic outcomes were analyzed with regard to patient and provider characteristics using bivariate and multivariate regression analyses.
In-hospital complications, mortality, mean length of stay (LOS), and mean total hospital costs.
A total of 6320 cases were identified with 0% mortality and a complication rate of 18.4%. The mean (SD) LOS was 3.3 (0.3) days, and the mean inpatient cost was $10 708 ($505). Independent predictors of donor complications included older age (odds ratio [OR], 1.01), male sex (OR, 1.19), Charlson Comorbidity Index of at least 1 (OR, 1.49), obesity (OR, 1.76), medium-size hospitals (OR, 1.88), and low-volume hospitals (OR, 1.37). Predictors of longer LOS included older age, female sex, Charlson score of at least 1, lower household income, low-volume and urban hospitals, and low-volume surgeons.
Kidney donation is associated with a low mortality rate but an 18% complication rate. Donation by those with advanced age or obesity is associated with higher risks. Informed consent should include discussion of these risks.
对活体供肾者安全的担忧限制了肾移植最大化的努力。已有病例系列研究和中心调查，但缺乏全国性的汇总数据。我们试图确定活体供肾肾切除术后早期临床和经济结局的预测因素。
利用医疗成本和利用项目全国住院患者样本1999 - 2005年出院数据进行回顾性横断面分析。通过国际疾病分类第九版（ICD - 9）编码识别病例。使用双变量和多变量回归分析，针对患者和医疗服务提供者的特征分析临床和经济结局。
医疗成本和利用项目全国住院患者样本。
通过ICD - 9编码识别的接受活体供肾肾切除术的患者。
使用双变量和多变量回归分析，针对患者和医疗服务提供者的特征分析临床和经济结局。
住院并发症、死亡率、平均住院时间（LOS）和平均总住院费用。
共识别出6320例病例，死亡率为0%，并发症发生率为18.4%。平均（标准差）住院时间为3.3（0.3）天，平均住院费用为10708美元（505美元）。供者并发症的独立预测因素包括年龄较大（比值比[OR]，1.01）、男性（OR，1.19）、Charlson合并症指数至少为1（OR，1.49）、肥胖（OR，1.76）、中等规模医院（OR，1.88）和低容量医院（OR，1.37）。住院时间较长的预测因素包括年龄较大、女性、Charlson评分至少为1、家庭收入较低、低容量和城市医院以及低容量外科医生。
肾捐赠死亡率较低，但并发症发生率为18%。高龄或肥胖者捐赠风险较高。知情同意应包括对这些风险的讨论。
