Trends in utilization and perioperative outcomes in live donor nephrectomies: a multi-surgical discipline analysis

We aim to analyze the trends in donor nephrectomy (DN) across three surgical disciplines-urology, general surgery, and transplant surgery, specifically to analyze the surgical techniques and perioperative outcomes.

We reviewed all live DN reported in the Statewide Planning and Research Cooperative System database of New York State (NYS) from 1995 to 2015. Surgeons were grouped in their respective disciplines using their state license number and the American Medical Association masterfile. We analyzed the volume of DN performed by each group along with how the surgical approach is, such as open, laparoscopic or robotic. Perioperative outcomes assessed were length of stay (LOS), 30-day and 90-day readmission rates, and complication rates RESULTS: A total of 6803 DN were performed with urologists, transplant surgeons and general surgeons accounting for 42%, 29%, and 29% of them, respectively. Urologists performed a higher case volume with a mean surgical volume of 17.4 ± 6.5 per year (p < 0.0001). During the study period, case volumes for urologists and transplant surgeons trended upward, while those for general surgeons trended downward. Urologists also utilized a minimally invasive surgery (MIS) such as laparoscopy or robotic approach in a higher percentage of their cases (p < 0.0001). Regarding perioperative outcomes, general surgeons had a higher mean LOS (p < 0.0001), while transplant surgeons had higher rates of 30-day and 90-day readmission rates (p < 0.0001). There were no statistically significant differences in complication rates following DN among the groups.

Urologists remain vital members of the renal transplantation team as they perform a majority of DN in NYS and are increasingly achieving them via an MIS approach when compared to their general and transplant surgery counterparts. Perioperative outcomes are similar amongst all disciplines; however, general surgeons have higher mean LOS, while transplant surgeons have higher readmission rates.