Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
Eur Urol. 2013 Jun;63(6):1107-14. doi: 10.1016/j.eururo.2012.08.069. Epub 2012 Sep 7.
The risk of in-hospital mortality after cytoreductive nephrectomy (CNT) is non-negligible and may vary widely according to various patient and hospital characteristics and clinical contexts.
To better elucidate the mechanisms underlying variability in operative mortality after CNT.
DESIGN, SETTING, AND PATIENTS: Using the US-based Nationwide Inpatient Sample registry, a weighted estimate of 16 285 patients with metastatic renal cell carcinoma (mRCC) treated with CNT between 1998 and 2007 was made retrospectively.
Failure to rescue (FTR), defined as the number of deaths in patients who developed an adverse outcome during hospitalization. Univariable and multivariable logistic regression models were used.
Of all 16 285 mRCC patients who underwent a CNT, 31% had an occurrence of one complication or more. The overall FTR rate was 5% and differed significantly according to age (≥ 75 yr vs <75 yr: 7.9% vs 4.3%) and comorbidities (≥ 3 vs 0: 7.7% vs 4.8%), as well as hospital bed size (small vs large: 7.2% vs 5.3%, all p ≤ 0.03). Patients who had an occurrence of infections (19.3%), cardiac- (15.7%), respiratory- (11.4%), or vascular-related complications (16.5%) had significantly higher FTR rates. It is noteworthy that increasing hospital volume and number of hospital beds also corresponded to lower rates of FTR after adjusting for other covariates.
Following CNT for mRCC, the occurrence of infections, cardiac-, respiratory-, or vascular-related complications resulted in higher FTR rates. Hospitals with greater number of beds and higher annual hospital volume had lower FTR rates, confirming the concepts that support FTR as an indicator for better quality of care following a high-risk surgical procedure.
细胞减灭性肾切除术（CNT）后的住院死亡率不容忽视，且可能因患者和医院的各种特征以及临床情况而有很大差异。
更好地阐明 CNT 术后手术死亡率差异的机制。
设计、设置和患者：使用基于美国的全国住院患者样本登记处，对 1998 年至 2007 年间接受 CNT 治疗的 16285 例转移性肾细胞癌（mRCC）患者进行了回顾性加权估计。
失败抢救（FTR）定义为在住院期间发生不良结局的患者的死亡人数。使用单变量和多变量逻辑回归模型。
在所有接受 CNT 的 16285 例 mRCC 患者中，31%发生了 1 种或多种并发症。总体 FTR 率为 5%，且根据年龄（≥75 岁与<75 岁：7.9%与 4.3%）和合并症（≥3 种与 0 种：7.7%与 4.8%）以及医院床位数（小与大：7.2%与 5.3%，所有 p≤0.03）差异有统计学意义。发生感染（19.3%）、心脏（15.7%）、呼吸（11.4%）或血管相关并发症（16.5%）的患者 FTR 率显著更高。值得注意的是，在调整了其他协变量后，医院容量和床位数的增加也与 FTR 降低相关。
在 mRCC 接受 CNT 后，发生感染、心脏、呼吸或血管相关并发症会导致更高的 FTR 率。床位数量更多和年住院量更高的医院 FTR 率更低，证实了 FTR 作为高风险手术术后更好护理质量的指标的概念。
