Predictors of hemorrhage after laparoscopic partial nephrectomy

Lee Richstone, Sylvia Montag, Michael C. Ost, Ernesto Reggio, Casey Seideman, Sompol Permpongkosol, Ardeshir R. Rastinehad, Louis R. Kavoussi

Research output: Contribution to journalArticle

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Abstract

Objectives: To identify risk factors associated with hemorrhage during laparoscopic partial nephrectomy (LPN), and to determine the impact of hemorrhage on hospital course. Methods: We retrospectively analyzed prospective data from 335 LPNs to identify clinicopathologic factors associated with hemorrhagic complications (blood loss requiring < 1 U transfusion) and extended length of hospitalization (< 3 days). We excluded patients with a coagulopathy or perioperative vascular injuries. Results: We identified 23 patients (7%) undergoing LPN with hemorrhagic complications (group 1 and 312 patients (93%) without complications (group 2). Mean age was 64.1 ± 14.4 vs 57.6 ± 12.7(P = .006), American Society of Anesthesiologists (ASA) score < 3 seen in 61% vs 37% (P = .02), mean tumor size (cm) was 2.90 ± 2.02 vs 2.59 ± 1.15 (P = .93), mean total operative time (min) was 250.1 ± 116.1 vs 191.8 ± 69.2 (P = 0.006), and mean hospital stay (days) was 4.7 ± 3.4 vs 3.1 ± 3.0 (P = .0002), for groups 1 and 2, respectively. Hypertension, diabetes mellitus, chronic renal insufficiency, obesity, smoking, and coronary artery diseasecongestive heart failure were present in group 1 vs group 2: 39.1% vs 31.4% (P = .4), 17.4% vs 8% (P = .12), 8.7% vs 1.9% (P = .09), 4.3% vs 3.5% (P = .57), 17.4% vs 5.4% (P = .04), and 8.7% vs 2.2% (P = .11), respectively. On multivariate analysis, smoking (P < .0437) and ASA score < 3 (P < .0233) were associated with hemorrhagic complications. Hemorrhagic complications were 3.5 times more likely in smokers than nonsmokers (95% confidence interval, 1.0-11.7), and 2.9 times more likely with an ASA class < 3. Only age (P < .0002) and operative time (P < .0001) were associated with longer hospitalization. Conclusions: High ASA scores and smoking are risk factors for hemorrhagic complications during LPN. Hemorrhagic complications did not significantly affect hospitalization length.

Original languageEnglish (US)
Pages (from-to)88-91
Number of pages4
JournalUrology
Volume77
Issue number1
DOIs
StatePublished - Jan 1 2011
Externally publishedYes

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Nephrectomy
Hospitalization
Smoking
Operative Time
Hemorrhage
Vascular System Injuries
Chronic Renal Insufficiency
Length of Stay
Coronary Vessels
Diabetes Mellitus
Multivariate Analysis
Heart Failure
Obesity
Confidence Intervals
Hypertension
Anesthesiologists
Neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Richstone, L., Montag, S., Ost, M. C., Reggio, E., Seideman, C., Permpongkosol, S., ... Kavoussi, L. R. (2011). Predictors of hemorrhage after laparoscopic partial nephrectomy. Urology, 77(1), 88-91. https://doi.org/10.1016/j.urology.2008.05.022

Predictors of hemorrhage after laparoscopic partial nephrectomy. / Richstone, Lee; Montag, Sylvia; Ost, Michael C.; Reggio, Ernesto; Seideman, Casey; Permpongkosol, Sompol; Rastinehad, Ardeshir R.; Kavoussi, Louis R.

In: Urology, Vol. 77, No. 1, 01.01.2011, p. 88-91.

Research output: Contribution to journalArticle

Richstone, L, Montag, S, Ost, MC, Reggio, E, Seideman, C, Permpongkosol, S, Rastinehad, AR & Kavoussi, LR 2011, 'Predictors of hemorrhage after laparoscopic partial nephrectomy', Urology, vol. 77, no. 1, pp. 88-91. https://doi.org/10.1016/j.urology.2008.05.022
Richstone L, Montag S, Ost MC, Reggio E, Seideman C, Permpongkosol S et al. Predictors of hemorrhage after laparoscopic partial nephrectomy. Urology. 2011 Jan 1;77(1):88-91. https://doi.org/10.1016/j.urology.2008.05.022
Richstone, Lee ; Montag, Sylvia ; Ost, Michael C. ; Reggio, Ernesto ; Seideman, Casey ; Permpongkosol, Sompol ; Rastinehad, Ardeshir R. ; Kavoussi, Louis R. / Predictors of hemorrhage after laparoscopic partial nephrectomy. In: Urology. 2011 ; Vol. 77, No. 1. pp. 88-91.
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abstract = "Objectives: To identify risk factors associated with hemorrhage during laparoscopic partial nephrectomy (LPN), and to determine the impact of hemorrhage on hospital course. Methods: We retrospectively analyzed prospective data from 335 LPNs to identify clinicopathologic factors associated with hemorrhagic complications (blood loss requiring < 1 U transfusion) and extended length of hospitalization (< 3 days). We excluded patients with a coagulopathy or perioperative vascular injuries. Results: We identified 23 patients (7{\%}) undergoing LPN with hemorrhagic complications (group 1 and 312 patients (93{\%}) without complications (group 2). Mean age was 64.1 ± 14.4 vs 57.6 ± 12.7(P = .006), American Society of Anesthesiologists (ASA) score < 3 seen in 61{\%} vs 37{\%} (P = .02), mean tumor size (cm) was 2.90 ± 2.02 vs 2.59 ± 1.15 (P = .93), mean total operative time (min) was 250.1 ± 116.1 vs 191.8 ± 69.2 (P = 0.006), and mean hospital stay (days) was 4.7 ± 3.4 vs 3.1 ± 3.0 (P = .0002), for groups 1 and 2, respectively. Hypertension, diabetes mellitus, chronic renal insufficiency, obesity, smoking, and coronary artery diseasecongestive heart failure were present in group 1 vs group 2: 39.1{\%} vs 31.4{\%} (P = .4), 17.4{\%} vs 8{\%} (P = .12), 8.7{\%} vs 1.9{\%} (P = .09), 4.3{\%} vs 3.5{\%} (P = .57), 17.4{\%} vs 5.4{\%} (P = .04), and 8.7{\%} vs 2.2{\%} (P = .11), respectively. On multivariate analysis, smoking (P < .0437) and ASA score < 3 (P < .0233) were associated with hemorrhagic complications. Hemorrhagic complications were 3.5 times more likely in smokers than nonsmokers (95{\%} confidence interval, 1.0-11.7), and 2.9 times more likely with an ASA class < 3. Only age (P < .0002) and operative time (P < .0001) were associated with longer hospitalization. Conclusions: High ASA scores and smoking are risk factors for hemorrhagic complications during LPN. Hemorrhagic complications did not significantly affect hospitalization length.",
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AU - Montag, Sylvia

AU - Ost, Michael C.

AU - Reggio, Ernesto

AU - Seideman, Casey

AU - Permpongkosol, Sompol

AU - Rastinehad, Ardeshir R.

AU - Kavoussi, Louis R.

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N2 - Objectives: To identify risk factors associated with hemorrhage during laparoscopic partial nephrectomy (LPN), and to determine the impact of hemorrhage on hospital course. Methods: We retrospectively analyzed prospective data from 335 LPNs to identify clinicopathologic factors associated with hemorrhagic complications (blood loss requiring < 1 U transfusion) and extended length of hospitalization (< 3 days). We excluded patients with a coagulopathy or perioperative vascular injuries. Results: We identified 23 patients (7%) undergoing LPN with hemorrhagic complications (group 1 and 312 patients (93%) without complications (group 2). Mean age was 64.1 ± 14.4 vs 57.6 ± 12.7(P = .006), American Society of Anesthesiologists (ASA) score < 3 seen in 61% vs 37% (P = .02), mean tumor size (cm) was 2.90 ± 2.02 vs 2.59 ± 1.15 (P = .93), mean total operative time (min) was 250.1 ± 116.1 vs 191.8 ± 69.2 (P = 0.006), and mean hospital stay (days) was 4.7 ± 3.4 vs 3.1 ± 3.0 (P = .0002), for groups 1 and 2, respectively. Hypertension, diabetes mellitus, chronic renal insufficiency, obesity, smoking, and coronary artery diseasecongestive heart failure were present in group 1 vs group 2: 39.1% vs 31.4% (P = .4), 17.4% vs 8% (P = .12), 8.7% vs 1.9% (P = .09), 4.3% vs 3.5% (P = .57), 17.4% vs 5.4% (P = .04), and 8.7% vs 2.2% (P = .11), respectively. On multivariate analysis, smoking (P < .0437) and ASA score < 3 (P < .0233) were associated with hemorrhagic complications. Hemorrhagic complications were 3.5 times more likely in smokers than nonsmokers (95% confidence interval, 1.0-11.7), and 2.9 times more likely with an ASA class < 3. Only age (P < .0002) and operative time (P < .0001) were associated with longer hospitalization. Conclusions: High ASA scores and smoking are risk factors for hemorrhagic complications during LPN. Hemorrhagic complications did not significantly affect hospitalization length.

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