Characterizing the Hospital Caseload-Outcome Relationship for Radical Nephrectomy With Inferior Vena Cava Tumor...

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Radical nephrectomy (RN) for renal cell carcinoma (RCC) with inferior vena cava (IVC) and cardiac venous tumor thrombectomy (VTT) is a complex procedure.
• These procedures are associated with significant morbidity and mortality.
• Understanding factors influencing patient outcomes is crucial for optimizing care.

Purpose of the Study:

• To characterize hospital complications following RN for RCC with IVC and cardiac VTT.
• To evaluate the relationship between hospital caseload and patient outcomes in these complex cases.

Main Methods:

• A pooled, cross-sectional analysis of the 2016-2020 National Inpatient Sample (NIS) database.
• Identification of patients undergoing RN for RCC with IVC- or cardiac-VTT.
• Categorization of complications using a Clavien system approximation and analysis of hospital caseload impact on complication rates via multivariable logistic regression.

Main Results:

• Among 111,785 RN cases, 3.3% had IVC-VTT and 0.3% had cardiac-VTT.
• Major complications were higher in IVC-VTT (16.0%) and cardiac-VTT (43.3%) cases compared to RN without VTT (8.9%).
• Higher annual hospital caseload (>20 procedures) was associated with significantly lower complication rates (4% vs. 19% for <5 procedures) and fewer major complications (OR 0.56, P = .01).

Conclusions:

• RN for RCC with IVC and cardiac VTT is linked to substantial complications, especially in hospitals with low procedure volumes.
• Centralization of care to high-caseload centers is suggested to potentially improve outcomes for these complex surgical cases.
• Further research is warranted to elucidate the mechanisms driving these outcomes and to optimize care delivery systems.