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Introduction:Robotic assisted partial nephrectomy (RAPN) is a commonly performed to treat localized renal masses. Preoperative counseling of patients should include estimation of postoperative risk.
Materials & Methods:1837 consecutive RAPN procedures were identified from a database from 5 academic institutions. Preoperative characteristics including gender, age, body-mass index (BMI), anesthesia risk (ASA) score, Charlson comorbidity index (CCI), tumor imaging, solitary kidney status, previous abdominal surgery, and renal function were used to model risk of any reported complication. Comparisons between patients with vs. without complications were performed using chi-square tests for categorical data, and t-tests or non-parametric alternative Wilcoxon sum rank test for continuous data. Multivariable analyses to predicting complication were performed using logistic regression model.
Results:On univariate analysis, age >70 (OR=2.45, 95%CI 1.17-5.13, p=0.017), ASA 3-4 (OR=1.61, 95%CI 1.22-2.13, p-value=0.0008), CCI (OR=1.29, 95%CI 1.19-1.39, p-value<.0001), Preoperative tumor size ≥ 4cm (OR=1.60, 95%CI 1.08-2.36, p-value=0.019), Solitary kidney (OR=1.88, 95%CI 1.00-3.52, p-value=0.050), preoperative GFR (OR=0.99, 95%CI 0.98-1.00, p-value=0.045) and preoperative Creatinine (OR=2.12, 95%CI 1.47-3.07, p-value<.0001) were associated with an increased complication incidence. On multivariate logistic regression analysis, CCI and preoperative tumor size are the only 2 significant predictors of complication (AUC=0.664). Increasing CCI by 1 increased the complication risk almost 1.5 fold. The risk of complication for patients with tumor size ≥ 4 cm are almost 2 times than that of patients with tumor size < 2cm.
Conclusions:Preoperative patient characteristics should be used to counsel patients about postoperative risks. Using a multi-institutional cohort of patients, we offer a realistic assessment of postoperative risk.