کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
3924637 1253109 2009 8 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Thirty-Day Mortality After Nephrectomy: Clinical Implications for Informed Consent
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی زنان، زایمان و بهداشت زنان
پیش نمایش صفحه اول مقاله
Thirty-Day Mortality After Nephrectomy: Clinical Implications for Informed Consent
چکیده انگلیسی

BackgroundThe existing literature suggests that the surgical mortality (SM) observed with nephrectomy for localised disease varies from 0.6% to 3.6%.ObjectiveTo examine age- and stage-specific 30-d mortality (TDM) rates after partial or radical nephrectomy.Design, setting, and participantsWe relied on 24 535 assessable patients from the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) database.MeasurementsIn 12 283 patients, logistic regression models were used to develop a tool for pretreatment prediction of the probability of TDM according to individual patient and tumour characteristics. External validation was performed on 12 252 patients.Results and limitationsIn the entire cohort of 24 535 patients, 219 deaths occurred during the initial 30 d after nephrectomy (0.9% TDM rate). TDM increased with age (≤49 yr: 0.5% vs 50–59 yr: 0.7% vs 60–69 yr: 0.9% vs 70–79 yr: 1.2% vs ≥80 yr: 2.0%; χ2 trend p < 0.001) and stage (0.3% for T1–2N0M0 vs 1.3% for T3–4N0–2M0 vs 4.2% for T1–4N0–2M1; χ2 trend p = <0.001). TDM decreased in more recent years (1988–1993: 1.3% vs 1994–1998: 0.9% vs 1999–2002: 0.7% vs 2003–2004: 0.6%; χ2 trend p < 0.001) and was lower after partial versus radical nephrectomy (RN) (0.4% vs 0.9%; p = 0.008). Only age (p < 0.001) and stage (p < 0.001) achieved independent predictor status. The look-up table that relied on the regression coefficients of age and stage reached 79.4% accuracy in the external validation cohort.ConclusionsAge and stage are the foremost determinants of TDM after nephrectomy. Our model provides individual probabilities of TDM after nephrectomy, and its use should be highly encouraged during informed consent prior to planned nephrectomy.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: European Urology - Volume 56, Issue 6, December 2009, Pages 998–1005
نویسندگان
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