A novel preoperative model to predict 90-day surgical mortality in patients considered for renal cell carcinoma surgery

Adam C. Calaway, M. Francesca Monn, Clinton D. Bahler, Clint Cary, Ronald S. Boris

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Introduction: Surgical benefits for renal cell carcinoma must be weighed against competing causes of mortality, especially in the elderly patient population. We used a large cancer registry to evaluate the impact of patient and cancer-specific factors on 90-day mortality (90DM). A nomogram to predict the odds of short-term mortality was created. Materials and Methods: The National Cancer Database was queried to identify all patients with clinically localized, nonmetastatic disease treated with partial or radical nephrectomy. Using a random sample of 60%, multiple logistic regression with 90DM outcomes were performed to identify preoperative variables associated with mortality. Variables included age, sex, race, co-morbidity score, tumor size, and presence of a thrombus. A nomogram was created and tested on the remaining 40% of patients to predict 90DM. Results: 183,407 patients met inclusion criteria. Overall 90DM for the cohort was 1.9%. All preoperative variables significantly influenced the risk of 90DM. Patient age was by far the strongest predictor. Nomogram scores ranged from 0 to 12. Compared to patients with 0 to 1 points, those with 2 to 3 (odds ratio [OR] 2.89, 2.42–3.46; P < 0.001), 4 to 5 (OR 6.25, 5.26–7.43; P < 0.001), and >6 (OR 12.86, 10.83–15.27; P < 0.001) were at incrementally significantly higher odds of 90DM. Being >80 years of age alone placed patients into the highest risk of surgical mortality. Conclusions: Management of localized kidney cancer must consider competing causes of mortality, especially in elderly patients with multiple co-morbidities. We present a preoperative tool to calculate risk of surgical short-term mortality to aid surgeon–patient counseling.

Original languageEnglish (US)
Pages (from-to)470.e11-470.e17
JournalUrologic Oncology: Seminars and Original Investigations
Volume36
Issue number10
DOIs
StatePublished - Oct 2018

Keywords

  • Nomogram
  • Patient counseling
  • Perioperative mortality
  • Renal cell carcinoma
  • Risk prediction

ASJC Scopus subject areas

  • Oncology
  • Urology

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