Open Access

ARTICLE

The effect of gender on nephrectomy perioperative outcomes: a national survey

Jesse Sammon^1,*, Quoc-Dien Trinh^1,2,*, Maxine Sun², Marco Bianchi^2,3, Jan Schmitges^2,4, Shahrokh F. Shariat⁵, Khurshid R. Ghani¹, Shyam Sukumar¹, Claudio Jeldres², Alberto Briganti³, Paul Perrotte², Craig G. Rogers¹, James O. Peabody¹, Francesco Montorsi³, Mani Menon¹, Pierre I. Karakiewicz²

1 Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
2 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
3 Department of Urology, Vita-Salute University, Urological Research Institute, Milan, Italy
4 Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
5 Department of Urology, Weill Medical College of Cornell University, New York, New York, USA
* equal contribution as frst author
Address correspondence to Dr. Jesse Sammon, Vattikuti Urology Institute, K-9 Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202 USA

Canadian Journal of Urology 2012, 19(4), 6337-6344.

Abstract

Introduction: The effect of gender on complications after surgery is controversial. We examine the effect of gender on five short term nephrectomy outcomes.
Materials and methods: Within the Health Care Utilization Project, Nationwide Inpatient Sample (NIS) we focused on nephrectomies performed within the most contemporary years (1998-2007). We tested the rates of blood transfusions, extended length of stay, in-hospital mortality, as well as intraoperative and postoperative complications, stratified according to gender. Multivariable logistic regression analyses fitted with general estimation equations for clustering among hospitals further adjusted for confounding factors. Separate multivariable analyses were performed for open radical nephrectomy (ORN), open partial nephrectomy (OPN), laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN).
Results: Overall, 48172 nephrectomies were identified. Of those, female patients accounted 39.4% of cases (n=18966). Female gender was associated with higher rates of blood transfusions (p<0.001) and higher rates of prolonged length of stay (p<0.001). Conversely, female gender was associated with lower rates of postoperative complications (p < 0.001) and in-hospital mortality (p = 0.015). In multivariable analyses, female patients had higher rates of blood transfusion (OR = 1.22, p < 0.001) but significantly lower rates of postoperative complications (OR = 0.81, p < 0.001) and in-hospital mortality. No statistically significant differences were recorded for intraoperative complications and length of stay beyond the median (all p>0.05). Gender as a predictor of outcomes was most pronounced in OPN and LPN.
Conclusions: Nephrectomies performed in female patients are associated with lower rates of postoperative complications and in-hospital mortality. Conversely, blood transfusions rates are higher in these patients. Gender disparities in perioperative outcomes are most pronounced after OPN.

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