Complications After Radical Nephrectomy According to Age: Analysis from the British Association of Urological Surgeons Nephrectomy Audit

Abstract

Introduction:

To compare complication rates in radical nephrectomy (RN) for renal cell carcinoma (RCC) across different age groups.

Methods:

Retrospective analysis of the British Association of Urological Surgeons Nephrectomy audit database between January 1, 2012, and December 31, 2017, was performed. Comparisons were made between different age groups (<60, 60–79, and ≥80) in patients undergoing RN for RCC.

Results:

Eighteen thousand four hundred thirty-eight patients with RCC underwent RN: 6128 (33.2%) <60 years of age, 10,785 (58.5%) 60–79 years of age, and 1525 (8.3%) ≥80 years of age. There was a significantly lower preoperative hemoglobin and estimated glomerular filtration rate with advancing age (p < 0.001). Patients ≥80 had a higher Charlson comorbidity index and World Health Organization (WHO) performance status (p < 0.001). There was also significant variability in the approach to RN (p < 0.001): laparoscopy was most commonly performed (68.8% vs 69.3% vs 75.0%). Patients ≥80 years of age were found to have the shortest operating time (p < 0.001). There were significant differences in T stage between groups with patients ≥80 years of age having a higher T stage (p < 0.001). The incidence of intraoperative complications did not significantly differ between age groups (p = 0.18). The incidence of postoperative complications was 15.7%, 18.2%, and 20.5% and major postoperative complications was 1.4%, 2.1%, and 2.8% in patients <60, 60–79, and ≥80 years of age, respectively (p < 0.001). The most common complication in all age groups was blood transfusion (7.6% <60, 8.6% 60–79, and 9.1% ≥ 80 years of age). Stepwise logistic regression analysis adjusting for additional variables found the odds of a postoperative complication increased with age with an odds ratio of 1.25 in patients ≥80 years of age and an odds ratio of 1.09 in patients 60–70 years of age compared with <60 years of age.

Conclusion:

Overall complications in all age groups are low, but advancing age should be considered an independent risk factor for postoperative complications after RN and should be appropriately considered when counseling elderly patients before treatment.