ORIGINAL ARTICLE   Free access

Minerva Urologica e Nefrologica 2019 February;71(1):47-54

DOI: 10.23736/S0393-2249.18.03202-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

The occurrence of intraoperative complications during partial nephrectomy and their impact on postoperative outcome: results from the RECORd1 project

Andrea MINERVINI ¹ ✉, Andrea MARI ¹, Marco BORGHESI ², Alessandro ANTONELLI ³, Riccardo BERTOLO ⁴, Giampaolo BIANCHI ⁵, Eugenio BRUNOCILLA ², Vincenzo FICARRA ⁶, Cristian FIORI ⁴, Nicola LONGO ⁷, Vincenzo MIRONE ⁷, Giuseppe MORGIA ⁸, Francesco PORPIGLIA ⁴, Bernardo ROCCO ⁹, Sergio SERNI ¹, Claudio SIMEONE ³, Riccardo TELLINI ¹, Alessandro VOLPE ¹⁰, Marco CARINI ¹, Riccardo SCHIAVINA ²

¹ Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; ² Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; ³ Department of Urology, Spedali Civili Hospital, Brescia, Italy; ⁴ Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy; ⁵ Department of Urology, Polyclinic of Modena, University of Modena, Modena, Italy; ⁶ Department of Urology, University of Padua, Padua, Italy; ⁷ Department of Urology, Federico II Hospital, University of Naples, Naples, Italy; ⁸ Department of Urology, University of Catania, Catania, Italy; ⁹ Department of Urology, Ca’ Granda Foundation and Insitute for Research and Care, Maggiore Polyclinic Hospital, University of Milan, Milan, Italy; ¹⁰ Department of Urology, Maggiore della Carità Hospital, Novara, Italia

BACKGROUND: The aim of this study was to analyze the predictive factors of intraoperative complications in patients submitted to PN and the impact of intraoperative complications on postoperative outcomes.
METHODS: Data of 1055 patients who underwent PN for cortical renal masses were recorded from a multicenter prospective observational study (RECORd1 project).
RESULTS: Overall, 48 (5%) patients experienced 49 intraoperative complications (four medical, 45 surgical). At multivariable analysis, age (OR=1.02, 95% CI: 1.00-1.08, P=0.03), imperative versus elective surgical indication (OR=2.55, 95% CI: 1.12-5.85, P=0.03), open (OR=5.76, 95% CI: 1.05-9.21, P=0.01) and laparoscopic (OR=2.35, 95% CI: 1.11-4.95, P=0.03) versus robotic approaches resulted independent predictive factors of intraoperative complications. Patients experiencing intraoperative complications had a significantly higher rate of overall postoperative complications (41.6% vs. 17.3%, P<0.0001), surgical postoperative complications (29.2% vs. 12.6%, P<0.0001), Clavien 2 surgical postoperative complications (14.6% vs. 7.2%, P=0.05) and a significantly longer length of stay (8 [6-9] vs. 7 [5-8] days, P<0.0001) than those with an uneventful intraoperative course.
CONCLUSIONS: Efforts should be made to minimize the risk of intraoperative complications during PN, and, in that case, patients should be carefully monitored.

KEY WORDS: Intraoperative complications - Laparoscopy - Nephrectomy - Intraoperative complications - Robotics - Computer-assisted surgery