Qosja Neda, Geldmaker Laura E, Fuqua Taylor, Tiwari Vartika, Malik Hanna, Wu Sarah, Haehn Daniela A, Thomas Colleen S, Hochwald Alex, Thiel David D
Department of Urology, Mayo Clinic, Jacksonville, FL, USA.
Alix School of Medicine, Mayo Clinic, Phoenix, AZ, USA.
Transl Androl Urol. 2024 Nov 30;13(11):2376-2383. doi: 10.21037/tau-24-250. Epub 2024 Nov 28.
Standard postoperative care following laparoscopic radical nephrectomy (LRN) typically includes routine blood tests. Recent studies have assessed the safety of omitting routine postoperative labs in minimally invasive surgeries to reduce hospital costs. Our primary objective was to evaluate if routine postoperative day 1 (POD1) labs were necessary following LRN.
We evaluated 650 consecutive LRN performed by a single surgeon. Patients on dialysis or that previously had a renal transplant were excluded from the study. Our final analysis included 478 LRN. We examined POD1 labs of potassium (K), sodium (Na), and hemoglobin (Hgb) and their associations to preoperative and postoperative outcomes. Abnormal K at POD1 was defined as less than 3.5 mEq/L or greater than 5.0 mEq/L. Abnormal Na at POD1 was defined as less than 135 mEq/L or more than 145 mEq/L. Abnormal Hgb at POD1 was defined as POD1 Hgb less than 8 g/dL or POD1 Hgb 3.0 g/dL or more decrease from preoperative Hgb.
One or more abnormal POD1 labs were observed in 32.4% (155/478) patients. Sixty-five patients had abnormal Hgb, 57 had abnormal Na, and 53 had abnormal K. Preoperative patient factors associated with abnormal labs included older age [odds ratio (OR) 0.461; 95% confidence interval (CI): 0.26-0.809], higher Charlson comorbidity index (CCI) (OR 1.671; 95% CI: 1.036-2.7), and increased intraoperative blood loss (OR 1.213; 95% CI: 1.069-1.39; all P<0.05). Intraoperative variables such as longer operative time and complications were not significantly associated with abnormal labs (P>0.05).
Abnormal labs on POD1 following LRN were found in 32.4% of patients. POD1 lab tests appear to be needed following LRN in older patients with more comorbidities.
腹腔镜根治性肾切除术（LRN）后的标准术后护理通常包括常规血液检查。最近的研究评估了在微创手术中省略术后常规实验室检查以降低医院成本的安全性。我们的主要目标是评估LRN术后第1天（POD1）的常规实验室检查是否必要。
我们评估了由一位外科医生连续进行的650例LRN。透析患者或先前接受过肾移植的患者被排除在研究之外。我们的最终分析包括478例LRN。我们检查了POD1时的钾（K）、钠（Na）和血红蛋白（Hgb）实验室检查结果及其与术前和术后结果的关联。POD1时K异常定义为低于3.5 mEq/L或高于5.0 mEq/L。POD1时Na异常定义为低于135 mEq/L或高于145 mEq/L。POD1时Hgb异常定义为POD1时Hgb低于8 g/dL或POD1时Hgb较术前Hgb降低3.0 g/dL或更多。
32.4%（155/478）的患者观察到一项或多项POD1实验室检查结果异常。65例患者Hgb异常，57例患者Na异常，53例患者K异常。与实验室检查结果异常相关的术前患者因素包括年龄较大[比值比（OR）0.461；95%置信区间（CI）：0.26 - 0.809]、较高的Charlson合并症指数（CCI）（OR 1.671；95% CI：1.036 - 2.7）和术中失血量增加（OR 1.213；95% CI：1.069 - 1.39；所有P<0.05）。术中变量如手术时间较长和并发症与实验室检查结果异常无显著关联（P>0.05）。
LRN术后POD1时32.4%的患者实验室检查结果异常。对于合并症较多的老年患者，LRN术后似乎需要进行POD1实验室检查。
