A description of radical nephrectomy practice and outcomes in England: 1995–2002

Abstract

OBJECTIVES To describe national trends in the practice of radical nephrectomy (RN) in England between 1995 and 2002. METHODS Data were extracted from the Hospital Episode Statistics database of the Department of Health in England between 1995/1996 and 2001/2002. Patients were included in the study if an International Classification of Diseases diagnosis code (ICD‐10) for malignant neoplasm of the kidney, renal pelvis or ureter, and an operative procedure code (OPCS‐4) describing total or partial excision of the kidney by either a laparoscopic or open approach, were present in any of the diagnosis or operative procedure fields. Overall, 17 308 patients were included. RESULTS Patient age and the proportion who were men did not change over the study period. The proportion of patients admitted as an emergency decreased from 14.0% to 7.5% over this period (P < 0.001). The mean waiting duration increased by almost 6 days (P < 0.001) and length of stay by ≈ 1 day, from 11.7 days in 1995 to 10.8 days in 2001 (P < 0.001). In‐hospital mortality decreased from 2% to 1.5% (P = 0.134). In‐hospital mortality and length of stay were higher in older patients and in those admitted as an emergency. Women had a longer stay than men (11.5 vs 11.1 days), but in‐hospital mortality was higher in men (2.3% vs 1.6%). The national number of RNs per year increased by ≈ 20%, from 2254 in 1995 to 2671 in 2001. Over the same period the mean annual hospital volume of RN increased by ≈ 40%, from 17 in 1995 to 24 in 2001. The annual number of laparoscopic RNs nationally increased from seven in 1995 to 84 in 2002. CONCLUSIONS The annual number of RNs in England increased by almost a fifth and this was accompanied by an increase in annual hospital volume of about two‐fifths. There was a large proportional increase in the number of laparoscopic RNs. Emergency admission rates and length of stay decreased but this was not accompanied by a significant change in in‐hospital mortality rate.

Waiting Time From Initial Urological Consultation to Nephrectomy for Renal Cell Carcinoma—Does it Affect Survival?

“…There are only 3 studies in the urological literature that have addressed waiting times for renal cancer surgery. Nuttall et al found a mean waiting time from the decision to perform radical nephrectomy to surgery of 23.6 days, 12 while Subramonian et al found a mean waiting time of 26 days from the diagnosis of RCC to surgery. 13 The third study, which was performed by Simunovic et al, showed a median of 64 days in 58 patients from the time of referral to a specialist to the day of nephrectomy.…”

Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study

“…15 The major outcomes of chronic kidney disease are: loss of kidney function, sometimes leading to kidney failure; complications of reduced kidney function, such as hypertension, anaemia, malnutrition, neuropathy, and reduced quality of life; and increased risk of cardiovascular disease and mortality. [16][17][18] Because of raised awareness of important health risks associated with chronic kidney disease, 15-19 and worldwide data [8][9][10] showing the probable overuse of radical nephrectomy, we aimed to review our nephrectomy database and assess kidney function outcomes in patients undergoing surgery for small, solitary, renal cortical tumours.…”

Laparoscopic partial nephrectomy: the University of Saskatchewan (Regina division) experience

“…6 Similarly, in England, only 4% of 2671 renal cortical tumours were treated by partial nephrectomy in 2002. 7 These data indicate that the procedure is underused despite its benefits. Recognizing this similar shortcoming at our institution, we have become actively involved in our LPN program for treatment of T1 tumours.…”