Critical Care Therapy After Cytoreductive Nephrectomy for Metastatic Kidney Cancer.

Carolin Siech, Felix K H Chun, Luis A Kluth, Philipp Mandel, Benedikt Hoeh, Jordan A Goyal, Natali Rodriguez Peñaranda, Francesco Di Bello, Mario de Angelis, Letizia Maria Ippolita Jannello, Stefano Puliatti, Shahrokh F Shariat, Pierre I Karakiewicz, Fred Saad, Alberto Briganti, Nicola Longo, Zhe Tian, Ottavio de Cobelli

Journal: Critical care medicine 2025;53(1):e132-e139

PMID: 39774205

Full Text on Ingenta plc View on PubMed

Abstract

OBJECTIVES

To examine critical care therapy rates after cytoreductive nephrectomy in metastatic kidney cancer patients.

DESIGN, SETTING, AND PATIENTS

Relying on the National Inpatient Sample (2000-2019), we addressed critical care therapy use (total parenteral nutrition, invasive mechanical ventilation, renal replacement therapy, percutaneous endoscopic gastrostomy tube insertion, and tracheostomy) and in-hospital mortality in surgically treated metastatic kidney cancer patients. Estimated annual percentage changes and multivariable logistic regression models were fitted.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Of 10,915 patients, 802 (7.3%) received critical care therapy and 249 (2.4%) died in-hospital. Over time, critical care therapy rates did not differ significantly (6.6% in 2000 to 5.7% in 2019; p = 0.07), while in-hospital mortality decreased from 2.3% to 1.9% (p = 0.004). Age 71 years old or older (odds ratio [OR], 1.43; p < 0.001) and higher comorbidity burden (Charlson Comorbidity Index [CCI] ≥ 3: OR, 2.92; p < 0.001 and CCI 1-2: OR, 1.45; p < 0.001) independently predicted higher critical care therapy rates. Conversely, partial nephrectomy (OR, 0.51; p = 0.003) and minimally invasive surgery (OR, 0.33; p < 0.001) predicted lower critical care therapy rates. Virtually the same associations were recorded for in-hospital mortality.

CONCLUSIONS

After cytoreductive nephrectomy, critical care therapy rate was 7.3% vs. in-hospital mortality was 2.4%. Of patients at highest risk of critical care therapy need were those with CCI greater than or equal to 3 and those 71 years old or older. Ideally, these patients should represent targets for thorough assessment of risk factors for complications before cytoreductive nephrectomy.

Address: Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.; Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany.; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy.; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.; Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.; Università degli Studi di Milano, Milan, Italy.; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.; Department of Urology, AOU di Modena, University of Modena and Reggio Emilia, Modena, Italy.; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.; Department of Urology, Weill Cornell Medical College, New York, NY.; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.; Department of Urology, AOU di Modena, University of Modena and Reggio Emilia, Modena, Italy.; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.; Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.; Università degli Studi di Milano, Milan, Italy.; Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy.; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy.; Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany.

DOI: 10.1097/CCM.0000000000006496

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MeSH Terms: Humans, Kidney Neoplasms, Aged, Nephrectomy, Female, Male, Cytoreduction Surgical Procedures, Middle Aged, Critical Care, Hospital Mortality