Examine intraoperative and postoperative morbidity of ONU and LNU in a population-based cohort.
We relied on the US Nationwide Inpatient Sample (NIS) to identify patients with nonmetastatic UTUC treated with ONU or LNU between 1998 and 2009. Overall, 7401 (90.8%) and 754 (9.2%) patients underwent ONU and LNU, respectively. To adjust for potential baseline differences between the two groups, propensity-score-based matching was performed. This resulted in 3016 (80%) ONU patients matched to 754 (20%) LNU patients.
All patients underwent NU.
The rates of intra- and postoperative complications, blood transfusions, prolonged length of stay (pLOS), and in-hospital mortality were assessed for both procedures. Multivariable logistic regression analyses were performed within the cohort after propensity-score matching.
For ONU versus LNU respectively, the following rates were recorded: blood transfusions, 15%versus 10%(p < 0.001); intraoperative complications, 4.7%versus 2.1%(p = 0.002); postoperative complications, 17%versus 15%(p = 0.24); pLOS (鈮? d), 47%versus 28%(p < 0.001); in-hospital mortality, 1.3%versus 0.7%(p = 0.12). In multivariable logistic regression analyses, LNU patients were less likely to receive a blood transfusion (odds ratio [OR]: 0.6; p < 0.001), to experience any intraoperative complications (OR: 0.4; p = 0.002), and to have a pLOS (OR: 0.4; p < 0.001). Overall, postoperative complications were equivalent. However, LNU patients had fewer respiratory complications (OR: 0.4; p = 0.007). This study is limited by its retrospective nature.
After adjustment for potential selection biases, LNU is associated with fewer adverse intra- and perioperative outcomes than ONU.