心脏瓣膜置换术后行部分肾切除术和根治性肾切除术患者的围手术期并发症和院内死亡率。
Perioperative Complications and In-Hospital Mortality in Partial and Radical Nephrectomy Patients with Heart-Valve Replacement.
机构信息
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, Québec, Canada.
Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany.
出版信息
Ann Surg Oncol. 2024 Aug;31(8):5449-5456. doi: 10.1245/s10434-024-15228-6. Epub 2024 Mar 25.
BACKGROUND
In-hospital mortality and complication rates after partial and radical nephrectomy in patients with history of heart-valve replacement are unknown.
PATIENTS AND METHODS
Relying on the National Inpatient Sample (2000-2019), kidney cancer patients undergoing partial or radical nephrectomy were stratified according to presence or absence of heart-valve replacement. Multivariable logistic and Poisson regression models addressed adverse hospital outcomes.
RESULTS
Overall, 39,673 patients underwent partial nephrectomy versus 94,890 radical nephrectomy. Of those, 248 (0.6%) and 676 (0.7%) had a history of heart-valve replacement. Heart-valve replacement patients were older (median partial nephrectomy 69 versus 60 years; radical nephrectomy 71 versus 63 years), and more frequently exhibited Charlson comorbidity index ≥ 3 (partial nephrectomy 22 versus 12%; radical nephrectomy 32 versus 23%). In partial nephrectomy patients, history of heart-valve replacement increased the risk of cardiac complications [odds ratio (OR) 4.33; p < 0.001), blood transfusions (OR 2.00; p < 0.001), intraoperative complications (OR 1.53; p = 0.03), and longer hospital stay [rate ratio (RR) 1.25; p < 0.001], but not in-hospital mortality (p = 0.5). In radical nephrectomy patients, history of heart-valve replacement increased risk of postoperative bleeding (OR 4.13; p < 0.001), cardiac complications (OR 2.72; p < 0.001), intraoperative complications (OR 1.53; p < 0.001), blood transfusions (OR 1.27; p = 0.02), and longer hospital stay (RR 1.12; p < 0.001), but not in-hospital mortality (p = 0.5).
CONCLUSIONS
History of heart-valve replacement independently predicted four of twelve adverse outcomes in partial nephrectomy and five of twelve adverse outcomes in radical nephrectomy patients including intraoperative and cardiac complications, blood transfusions, and longer hospital stay. Conversely, no statistically significant differences were observed in in-hospital mortality.
背景
心脏瓣膜置换术后行部分肾切除术和根治性肾切除术患者的院内死亡率和并发症发生率尚不清楚。
患者和方法
利用国家住院患者样本（2000-2019 年），根据是否存在心脏瓣膜置换术将接受部分或根治性肾切除术的肾癌患者分层。多变量逻辑和泊松回归模型解决了不良医院结局。
结果
共有 39673 例患者接受部分肾切除术，94890 例接受根治性肾切除术。其中，248 例（0.6%）和 676 例（0.7%）有心脏瓣膜置换术史。心脏瓣膜置换术患者年龄较大（部分肾切除术中位数为 69 岁，而根治性肾切除术为 60 岁；71 岁，而根治性肾切除术为 63 岁），并且更频繁地表现出Charlson 合并症指数≥3（部分肾切除术 22%，而根治性肾切除术为 12%；32%，而根治性肾切除术为 23%）。在部分肾切除术患者中，心脏瓣膜置换术史增加了心脏并发症的风险[比值比（OR）4.33；p<0.001），输血（OR 2.00；p<0.001），术中并发症（OR 1.53；p=0.03）和住院时间延长[率比（RR）1.25；p<0.001]，但不会导致院内死亡率增加（p=0.5）。在根治性肾切除术患者中，心脏瓣膜置换术史增加了术后出血（OR 4.13；p<0.001），心脏并发症（OR 2.72；p<0.001），术中并发症（OR 1.53；p<0.001），输血（OR 1.27；p=0.02）和住院时间延长（RR 1.12；p<0.001），但不会导致院内死亡率增加（p=0.5）。
结论
心脏瓣膜置换术史独立预测部分肾切除术 12 项不良结局中的 4 项和根治性肾切除术 12 项不良结局中的 5 项，包括术中并发症和心脏并发症，输血和住院时间延长。相反，在院内死亡率方面没有观察到统计学上的显著差异。
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