Predictors of Adverse Outcomes Following Nephrectomy for Pediatric Renal Tumors: Analysis of National Surgical Quality Improvement Program—Pediatric Data

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-04-24 DOI:10.1016/j.jss.2025.03.026

Humza Thobani MBBS , Rafia Durrani MBBS , Steven L. Raymond MD , Adil A. Shah MD , Bill Chiu MD , Peter F. Ehrlich MD, MSc , Saleem Islam MD, MPH , Faraz A. Khan MD

{"title":"Predictors of Adverse Outcomes Following Nephrectomy for Pediatric Renal Tumors: Analysis of National Surgical Quality Improvement Program—Pediatric Data","authors":"Humza Thobani MBBS , Rafia Durrani MBBS , Steven L. Raymond MD , Adil A. Shah MD , Bill Chiu MD , Peter F. Ehrlich MD, MSc , Saleem Islam MD, MPH , Faraz A. Khan MD","doi":"10.1016/j.jss.2025.03.026","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to characterize the 30-d outcomes of nephrectomies for renal tumors (RTs) in children and identify predictors of operative morbidity.</div></div><div><h3>Methods</h3><div>We queried the National Surgical Quality Improvement Program—Pediatric database for children aged <18 y with RTs who underwent nephrectomy from 2012 to 2021. Relevant clinical variables relating to patient demographics, outcomes, and type of nephrectomy were extracted. The primary outcome variable was any major adverse outcome (MAO). The secondary outcome variable was intra- or post-operative transfusion of blood products. Multivariable logistic regression was conducted to identify possible predictors of the primary or secondary outcomes after multiple imputations to account for missing data.</div></div><div><h3>Results</h3><div>We identified 1759 patients with a median age of 3.6 y (interquartile range: 1.9-5.8 y) and an equal sex distribution (51.4% female). Approximately 4.7% of patients had an MAO and 29.8% had a transfusion event. On multivariate regression, the predictors most strongly associated with MAO were a history of chronic lung disease (adjusted odds ratio [aOR] = 1.329, 95% confidence interval [CI] = 1.206-1.465), preoperative nutritional support (aOR = 1.129, 95% CI = 1.074-1.188), and prior inotropic support (aOR = 1.100, 95% CI = 1.010-1.198). A nephron sparing approach was associated with a slightly higher odds of both MAO (aOR = 1.044, 95% CI = 1.015-1.074) and intra-/post-operative transfusion (aOR = 1.109, 95% CI = 1.045-1.177).</div></div><div><h3>Conclusions</h3><div>Patients undergoing nephrectomy for RTs had low rates of surgical mortality and complications. A nephron sparing approach appeared to be associated with a slightly higher odds of operative morbidity—this may be because patients selected for nephron sparing surgery likely had higher stage, bilateral tumors, or a genetic predisposition to developing RTs.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 128-136"},"PeriodicalIF":1.8000,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022480425001477","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

This study aimed to characterize the 30-d outcomes of nephrectomies for renal tumors (RTs) in children and identify predictors of operative morbidity.

Methods

We queried the National Surgical Quality Improvement Program—Pediatric database for children aged <18 y with RTs who underwent nephrectomy from 2012 to 2021. Relevant clinical variables relating to patient demographics, outcomes, and type of nephrectomy were extracted. The primary outcome variable was any major adverse outcome (MAO). The secondary outcome variable was intra- or post-operative transfusion of blood products. Multivariable logistic regression was conducted to identify possible predictors of the primary or secondary outcomes after multiple imputations to account for missing data.

Results

We identified 1759 patients with a median age of 3.6 y (interquartile range: 1.9-5.8 y) and an equal sex distribution (51.4% female). Approximately 4.7% of patients had an MAO and 29.8% had a transfusion event. On multivariate regression, the predictors most strongly associated with MAO were a history of chronic lung disease (adjusted odds ratio [aOR] = 1.329, 95% confidence interval [CI] = 1.206-1.465), preoperative nutritional support (aOR = 1.129, 95% CI = 1.074-1.188), and prior inotropic support (aOR = 1.100, 95% CI = 1.010-1.198). A nephron sparing approach was associated with a slightly higher odds of both MAO (aOR = 1.044, 95% CI = 1.015-1.074) and intra-/post-operative transfusion (aOR = 1.109, 95% CI = 1.045-1.177).

Conclusions

Patients undergoing nephrectomy for RTs had low rates of surgical mortality and complications. A nephron sparing approach appeared to be associated with a slightly higher odds of operative morbidity—this may be because patients selected for nephron sparing surgery likely had higher stage, bilateral tumors, or a genetic predisposition to developing RTs.

查看原文本刊更多论文

儿童肾肿瘤肾切除术后不良后果的预测因素：国家手术质量改进计划-儿童数据分析

本研究旨在描述儿童肾肿瘤（RTs）切除后30天的预后，并确定手术并发症的预测因素。方法：我们查询了2012年至2021年接受肾切除术的18岁RTs患儿的国家手术质量改进计划-儿科数据库。提取与患者人口统计学、结局和肾切除术类型相关的临床变量。主要结局变量为任何主要不良结局（MAO）。次要结局变量是术中或术后输血。进行多变量逻辑回归，以确定多重输入后主要或次要结果的可能预测因子，以解释缺失的数据。结果1759例患者中位年龄为3.6岁（四分位数范围为1.9-5.8岁），性别分布均匀（51.4%为女性）。大约4.7%的患者发生MAO， 29.8%的患者发生输血事件。在多因素回归中，与MAO相关性最强的预测因素是慢性肺部疾病史（校正优势比[aOR] = 1.329, 95%可信区间[CI] = 1.206-1.465）、术前营养支持（aOR = 1.129, 95% CI = 1.074-1.188）和既往肌力支持（aOR = 1.100, 95% CI = 1.010-1.198）。保留肾元入路与MAO （aOR = 1.044, 95% CI = 1.015-1.074）和术中/术后输血（aOR = 1.109, 95% CI = 1.045-1.177）的几率略高相关。结论肾切除术患者手术死亡率低，并发症发生率低。保留肾元入路似乎与稍高的手术发病率相关——这可能是因为选择保留肾元手术的患者可能有较高的分期、双侧肿瘤或发生RTs的遗传易感。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.