Assessing the Burden of Complications After Surgery for Clinically Localized Kidney Cancer by Age and Comorbidity Status

OBJECTIVE To examine the association between high-risk patient status (age > 75 years or Charlson comorbidity index count > 2) and postoperative complications in patients undergoing surgical management for clinically localized renal tumors. MATERIALS AND METHODS Patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) (2005-2012) for localized renal cell carcinoma were analyzed. Multivariate logistic regressions were used to test the association between high-risk status and postoperative complications adjusting for patient, tumor, and operative characteristics. RESULTS Of 1092 patients undergoing PN (71.9%) or RN (28.1%) for clinically localized renal tumors, 255 (23.4%) were classified as high risk, and 175 patients (16%) developed at least 1 complication (mean 1.6 +/- 1.0). Of note, 22.4% and 14.1% of high-and low-risk patients developed a complication, respectively (P = .002). Comparing high-and low-risk patients, significant differences in Clavien I-II (20.4% vs 11.1%; P <. 001) and medical (16.1% vs 8.1%, P <. 001) complications were observed, whereas no differences were seen in Clavien III-V or surgical complications. No differences in complications were observed comparing patients treated with RN and PN, albeit high-risk patients were more likely to undergo RN (35.3% vs 25.9%, P = .04). After adjustment, the odds of incurring any complication were 1.9 times higher in highcompared with low-risk patients (odds ratio 1.9 [confidence interval 1.3-2.8]). CONCLUSION Regardless of surgical type, patients deemed high risk by age and comorbidity criteria were more likely to incur a postoperative complication after renal mass resection. Improved understanding of surgical risks in the elderly and infirmed will help better inform patients deciding between active surveillance and resection of renal tumors. (C) 2014 Elsevier Inc.