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Perioperative Nephrectomy Outcomes for Patients with Liver Disease: Implications for Liver Transplant Candidates

Published:November 17, 2022DOI:https://doi.org/10.1016/j.urology.2022.10.016

      Objective

      To improve the management of cirrhotic patients diagnosed with new renal masses, we used a nationally representative cohort to assess the perioperative outcomes of nephrectomy in the setting of liver disease. The incidences of liver disease and renal masses are both rising in the US. Delaying liver transplantation to address other health concerns may have life changing consequences in these patients, thus these results help to guide treatment decisions at this critical junction in care.

      Methods

      A retrospective study of the 2016-2019 Nationwide Readmissions Database was performed in adults undergoing nephrectomy for non-emergent indications. Outcomes were compared between three cohorts: no chronic liver disease (no CLD), chronic liver disease (CLD), and decompensated cirrhosis (DC). Mixed regression models were used to evaluate the association between CLD and DC with outcomes of interest including morbidity, mortality, readmission rates, non-home discharges, length of stay, and costs.

      Results

      A total of 183,362 patients were evaluated. The mortality rate in the DC cohort (7%) was higher than with CLD (0.4%) and no CLD (0.3%), (p<0.001). DC was associated with higher mortality (OR 8.29, 95% CI 4.07 - 16.88), post-operative bleeding requiring transfusion (OR 5.55, 95% CI 3.72 – 8.26), non-home discharge (OR 5.12, 95% CI 3.16 - 8.30) and readmission (OR 1.79, 95% CI 1.09 - 2.94) compared to no CLD. The DC cohort had the greatest length of stay and costs.

      Conclusions

      Patients undergoing nephrectomy with DC have increased morbidity, mortality, readmission rates, non-home discharges, LOS and costs. Alternative management strategies may be considered in these patients.

      Keywords

      Abbreviations:

      NRD (Nationwide Readmissions Database), No CLD (No chronic liver disease), CLD (Chronic liver disease), DC (Decompensated cirrhosis), ICD-10: PCS/CM (International Classification of Diseases, Tenth revision, Procedural Classification System and Clinical Modification), LOS (Length of stay), MIS (Minimally invasive surgery), NSQIP (National Surgical Quality Improvement Program), MELD (Model for End-Stage Liver Disease), AS (Active surveillance), RCC (Renal cell carcinoma), SRM (Small renal mass)
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