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Published in: Pediatric Surgery International 10/2014

01-10-2014 | Original Article

Perioperative outcomes of primary renal tumour resections: comparison of in-hours to out-of-hours surgery

Authors: Connor Forbes, Sonia A. Butterworth

Published in: Pediatric Surgery International | Issue 10/2014

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Abstract

Purpose

Primary resection is typically performed for children with localised suspected Wilms tumours. Resource limitation may necessitate performing these operations nights and weekends. We hypothesise that outcomes will be worse in patients having nephrectomies out-of-hours (OOH) compared to those in-hours (IH).

Methods

With IRB ethics approval, primary renal tumour resections performed on oncology patients from 1989–2011 were reviewed retrospectively. IH operations were defined as Monday–Friday 0745–1530 hours. Outcomes included major intraoperative complications, capsule rupture, and blood loss. Data were analysed using Fischer Exact and Mann–Whitney U tests.

Results

There were 64 patients with renal tumours who underwent primary resection. Forty-five procedures were performed IH, and 19 OOH. Groups were similar in age, ASA status, tumour size and grade. In a comparison of major intraoperative complications, capsule rupture, and mean blood loss, differences were 2 vs. 26 % (p = 0.007), 27 vs. 42 % (p = 0.12), 178 vs. 244 ml (p = 0.15) for IH and OOH respectively. There was one perioperative mortality (OOH).

Conclusions

Primary renal tumour resections performed OOH were associated with an increase in major complications compared to those performed in standard hours. Avoidance of OOH operating where possible may reduce morbidity for children undergoing primary renal tumour resections.
Literature
2.
go back to reference Grundy PE, Breslow NE, Li S et al (2005) Loss of heterozygosity for chromosomes 1p and 16q is an adverse prognostic factor in favorable-histology Wilms tumor: a report from the National Wilms Tumor Study Group. J Clin Oncol 23(29):7312–73213PubMedCrossRef Grundy PE, Breslow NE, Li S et al (2005) Loss of heterozygosity for chromosomes 1p and 16q is an adverse prognostic factor in favorable-histology Wilms tumor: a report from the National Wilms Tumor Study Group. J Clin Oncol 23(29):7312–73213PubMedCrossRef
3.
go back to reference Dome JS, Cotton CA, Perlman EJ et al (2006) Treatment of anaplastic histology Wilms’ tumor: results from the fifth National Wilms’ Tumor Study. J Clin Oncol 24(15):2352–23584PubMedCrossRef Dome JS, Cotton CA, Perlman EJ et al (2006) Treatment of anaplastic histology Wilms’ tumor: results from the fifth National Wilms’ Tumor Study. J Clin Oncol 24(15):2352–23584PubMedCrossRef
4.
go back to reference Shamberger RC, Anderson JR, Breslow NE et al (2010) Long-term outcomes for infants with very low risk Wilms tumor treated with surgery alone in National Wilms Tumor Study-5. Ann Surg 251(3):555–558PubMedCrossRefPubMedCentral Shamberger RC, Anderson JR, Breslow NE et al (2010) Long-term outcomes for infants with very low risk Wilms tumor treated with surgery alone in National Wilms Tumor Study-5. Ann Surg 251(3):555–558PubMedCrossRefPubMedCentral
5.
go back to reference Ricci WM, Gallagher B, Brandt A, Schwappach J, Tucker M, Leighton R (2009) Is after-hours orthopaedic surgery associated with adverse outcomes? A prospective comparative study. J Bone Joint Surg Am 01:2067–2072. doi:10.2106/JBJS.H.00661 CrossRef Ricci WM, Gallagher B, Brandt A, Schwappach J, Tucker M, Leighton R (2009) Is after-hours orthopaedic surgery associated with adverse outcomes? A prospective comparative study. J Bone Joint Surg Am 01:2067–2072. doi:10.​2106/​JBJS.​H.​00661 CrossRef
6.
go back to reference Aya AG, Mangin R, Robert C, Ferrer JM, Eledjam JJ (1999) Increased risk of unintentional dural puncture in night-time obstetric epidural anaesthesia. Can J Anaesth 46:665–669PubMedCrossRef Aya AG, Mangin R, Robert C, Ferrer JM, Eledjam JJ (1999) Increased risk of unintentional dural puncture in night-time obstetric epidural anaesthesia. Can J Anaesth 46:665–669PubMedCrossRef
8.
9.
go back to reference Turrentine F, Wang H, Young J, Calland J (2010) What is the safety of non-emergent operative procedures performed at night? A study of 10,426 operations at an academic tertiary care hospital using the American college of surgeons national surgical quality program improvement database. J Trauma 69:313–319. doi:10.1097/TA.0b013e3181e49291 PubMedCrossRef Turrentine F, Wang H, Young J, Calland J (2010) What is the safety of non-emergent operative procedures performed at night? A study of 10,426 operations at an academic tertiary care hospital using the American college of surgeons national surgical quality program improvement database. J Trauma 69:313–319. doi:10.​1097/​TA.​0b013e3181e49291​ PubMedCrossRef
13.
go back to reference Reebye SC, Blair GK, Rogers PC, Jamieson D, Skarsgard ED (2006) An audit of cancer diagnosis in a Canadian children’s hospital: quality, timing and efficiency. Paediatr Child Health 11:143–147PubMedPubMedCentral Reebye SC, Blair GK, Rogers PC, Jamieson D, Skarsgard ED (2006) An audit of cancer diagnosis in a Canadian children’s hospital: quality, timing and efficiency. Paediatr Child Health 11:143–147PubMedPubMedCentral
17.
go back to reference Schoem SR, Finck C (2012) Time out for surgeons: when is the attending surgeon too tired? Conn Med 76:171–172PubMed Schoem SR, Finck C (2012) Time out for surgeons: when is the attending surgeon too tired? Conn Med 76:171–172PubMed
18.
go back to reference Ritchey ML, Shamberger RC, Haase G, Horwitz J, Bergemann T, Breslow NE (2001) Surgical complications after primary nephrectomy for Wilms’ tumor: report from the National Wilms’ Tumor Study Group. J Am Coll Surg 192:63–638PubMedCrossRef Ritchey ML, Shamberger RC, Haase G, Horwitz J, Bergemann T, Breslow NE (2001) Surgical complications after primary nephrectomy for Wilms’ tumor: report from the National Wilms’ Tumor Study Group. J Am Coll Surg 192:63–638PubMedCrossRef
20.
go back to reference McCormick F, Kadzielski J, Landrigan CP, Evans B, Herndon JH, Rubash HE (2012) Surgeon fatigue: a prospective analysis of the incidence, risk, and intervals of predicted fatigue-related impairment in residents. Arch Surg 147:430–435. doi:10.1001/archsurg.2012.84 PubMedCrossRef McCormick F, Kadzielski J, Landrigan CP, Evans B, Herndon JH, Rubash HE (2012) Surgeon fatigue: a prospective analysis of the incidence, risk, and intervals of predicted fatigue-related impairment in residents. Arch Surg 147:430–435. doi:10.​1001/​archsurg.​2012.​84 PubMedCrossRef
21.
go back to reference de Kraker J, Graf N, van Tinteren H et al (2004) Reduction of postoperative chemotherapy in children with stage I intermediate-risk and anaplastic Wilms’ tumour (SIOP 93-01 trial): a randomised controlled trial. Lancet 364:1229–1235PubMedCrossRef de Kraker J, Graf N, van Tinteren H et al (2004) Reduction of postoperative chemotherapy in children with stage I intermediate-risk and anaplastic Wilms’ tumour (SIOP 93-01 trial): a randomised controlled trial. Lancet 364:1229–1235PubMedCrossRef
23.
go back to reference Jennings AG, Saeed K, Dolan S, Wise DI (1999) Impact of the introduction of a daily trauma list on out-of-hours operating. Ann R Coll Surg Engl 81:65–68PubMedPubMedCentral Jennings AG, Saeed K, Dolan S, Wise DI (1999) Impact of the introduction of a daily trauma list on out-of-hours operating. Ann R Coll Surg Engl 81:65–68PubMedPubMedCentral
Metadata
Title
Perioperative outcomes of primary renal tumour resections: comparison of in-hours to out-of-hours surgery
Authors
Connor Forbes
Sonia A. Butterworth
Publication date
01-10-2014
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Surgery International / Issue 10/2014
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-014-3560-4

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