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

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.