Complication rates, failure to rescue and in-hospital mortality after cytoreductive nephrectomy in the older patients

OBJECTIVES:
Historical data showed higher rates of morbidity following cytoreductive nephrectomy (CN) in older patients. We reassessed complication, failure to rescue (FTR) and mortality rates after CN in a contemporary cohort of older patients with metastatic renal cell carcinoma (mRCC).

MATERIALS AND METHODS:
From National Inpatient Sample (NIS) database (2008-2015), mRCC patients treated with CN were abstracted. Univariable and multivariable logistic regression models tested for the relationship between age (dichotomized as <75 vs. ≥75 years) and complications, length of stay (LOS), FTR and in-hospital mortality.

RESULTS:
Out of 3644 mRCC patients treated with CN, 558 (15.3%) were ≥ 75 years. Relative to younger, older patients experienced higher overall complications rates (56.8 vs. 43.3%, p < 0.001), longer LOS (median 6 vs. 5 days, p < 0.001), higher FTR rates (7.9 vs 3.1%, p < 0.001) and higher in-hospital mortality rates (4.5 vs 1.5%, p < 0.001). In multivariable logistic regression models, age ≥ 75 years was an independent predictors of higher rates of overall complications (odds ratio [OR] 1.4, p < 0.001), FTR (OR 2.0, p = 0.01) and in-hospital mortality (OR 2.1, p = 0.02). Conversely, age ≥ 75 years was not significantly associated with LOS above the median (p = 0.1).

CONCLUSION:
Older patients with mRCC are more likely to experience higher rates of overall complications, FTR and in-hospital mortality following CN. These results highlight the importance of rigorous selection criteria for older surgical candidates. Moreover, timely recognition and rapid response to complications are particularly critical in this population.