Use of Prostate-Specific Antigen Velocity as a Screening Tool for Pre-Biopsy Detection of Prostate Cancer in African-American Men: A Single Institutional Analysis

Abstract

INTRODUCTION:Rates of minimally invasive surgery are increasing relative to open surgery. We sought to compare the contemporary rates of short-term complications of open and laparoscopic renal surgery in pediatric patients. METHODS:A retrospective cross sectional analysis of the Pediatric NSQIP database was performed for all cases of partial and total nephrectomy reported in 2014. Cases were identified using ICD-9 procedure codes 50220, 50225, 50230, 50234, 50236, 50546, and 50548 for nephrectomy, and 50240 and 50543 for partial nephrectomy, and reviewed for postoperative complications. Univariate analysis was performed to determine risk factors for 30-day complications, with comparison between open and minimally invasive surgical approaches. RESULTS:Review identified 207 nephrectomies and 72 partial nephrectomies. Children undergoing laparoscopic nephrectomy were significantly older than those managed via open surgery (p ¼ 0.012), with a similar trend among partial nephrectomies (p ¼ 0.053). Children undergoing laparoscopic nephrectomy had greater body surface area than those treated by open surgery (p ¼ 0.004), but this difference was not significant among cases of partial nephrectomy (p ¼ 0.18). Operative time was significantly shorter for open vs laparoscopic nephrectomy (p < 0.001), but not for partial nephrectomy (p ¼ 0.8). Laparoscopic partial nephrectomies were associated with shorter length of stay relative to open surgery (p ¼ 0.001). There was no difference in all other 30-day complication rates measured.CONCLUSIONS: Minimally invasive pediatric renal surgery is associated with longer operative time for nephrectomy, but shorter length of stay after partial nephrectomy. Surgical approach was not found to impact short-term complications. Future cost-based analysis is warranted to better understand the optimal application of technology relative to patient care.