Lower complications are seen after laparoscopic kidney removalMost kidney-removal surgeries (radical nephrectomy) are now done via the minimally invasive laparoscopic route. The complication rate is lower for the laparoscopic compared to the open surgical approach, according to a new study. However, when patients did develop complications after laparoscopic nephrectomy, they were more likely to die from them (failure to rescue).
Using National Cancer Institute and Medicare data, the researchers identified 2,108 patients who underwent laparoscopic radical nephrectomy. A second group of 5,895 patients had their kidney removed via open surgery. Patients undergoing the laparoscopic approach had a lower rate of complications such as sepsis, infection, and injury after surgery (31.7 percent) compared to open-surgery patients (38.8 percent). However, laparascopic patients had a higher failure-to-rescue rate (7 percent vs. 4.8 percent for open-surgery patients). Gastrointestinal complications and care-related (iatrogenic) injury were more common in laparoscopic patients who died after surgery. Neurological complications were more common in open-surgery patients who died. Hospitals that performed a higher volume of these surgeries had lower rates of any complications regardless of surgical approach. Higher-volume surgeons had lower failure-to-rescue rates for laparoscopic patients than open patients.
Given the findings, the researchers believe that adverse events may be more difficult to recognize or manage successfully in patients undergoing laparoscopic radical nephrectomy. They call for more attention to patient safety, surgeon preparation, and hospital readiness to achieve better outcomes when complications arise in these patients. The study was supported in part by the Agency for Healthcare Research and Quality (HS18346).
See "Complications and failure to rescue after laparoscopic versus open radical nephrectomy," by Hung-Jui Tan, M.D., J. Stuart Wolf, Jr., M.D., Zaojun Ye, M.S., and others in the October 2011 Journal of Urology 186, pp. 1254-1260.
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