文章：

根治性肾切除术联合下腔静脉血栓切除术的围手术期结果

Perioperative Outcomes After Radical Nephrectomy with Inferior Vena Cava Thrombectomy

原文发布日期：24 March 2025

DOI: 10.3390/cancers17071083

类型: Article

开放获取: 是

英文摘要：

Background and Objective: We aimed to evaluate current trends and complications after radical nephrectomy with inferior vena cava (IVC) thrombectomy and to provide evidence on the role of the annual hospital caseload on perioperative outcomes. Methods: We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the German Bureau of Statistics (2005–2022). All hospitals performing radical nephrectomy with IVC thrombectomy were subclassified based on their annual caseload to low- (<3 cases/year), intermediate- (3–9 cases/year), and high-volume centers (≥10 cases/year). We included 3608 patients. Key Findings and Limitations: Overall, 1880 (52%) patients underwent surgery in low-, 1466 (40%) in intermediate-, and 848 (8%) in high-volume centers. Most patients (3574, 99%) underwent open surgery. The number of patients undergoing radical nephrectomy with IVC thrombectomy has decreased in the last years. Patients undergoing surgery in low-, intermediate- and high-volume centers had similar baseline characteristics. Operation in high-volume centers, compared to low-volume centers, was associated with lower odds of intensive care unit admission (29% versus 45%, OR: 0.5, 95% CI: 0.4–0.7,p< 0.001) and a shorter hospital stay by 3.9 days (95% CI: 2.2–5.6,p< 0.001). Importantly, for every additional case performed annually, hospitals improve their perioperative outcomes in terms of mortality (p= 0.032), intensive care unit admissions (p= 0.002), acute kidney disease (p= 0.029), and length of hospital stay (p< 0.001). Conclusions and Clinical Implications: The present real-world data demonstrate that, for every additional case performed annually, hospitals improve their perioperative outcomes in terms of major perioperative complications.

摘要翻译： 

背景与目的：本研究旨在评估根治性肾切除联合下腔静脉（IVC）取栓术的当前趋势与术后并发症，并探讨医院年手术量对围手术期结局的影响。方法：基于德国统计局提供的全国住院患者数据库（GRAND，2005-2022年），将开展根治性肾切除联合IVC取栓术的医院按年手术量分为低手术量中心（<3例/年）、中手术量中心（3-9例/年）和高手术量中心（≥10例/年）。研究共纳入3608例患者。核心发现与局限性：总体而言，1880例（52%）患者在低手术量中心接受手术，1466例（40%）在中手术量中心，848例（8%）在高手术量中心。绝大多数患者（3574例，99%）接受开放手术。近年来接受根治性肾切除联合IVC取栓术的患者数量呈下降趋势。不同手术量中心的患者基线特征相似。与低手术量中心相比，高手术量中心的手术与较低的ICU入住率相关（29%对45%，OR：0.5，95% CI：0.4-0.7，p<0.001），且住院时间缩短3.9天（95% CI：2.2-5.6，p<0.001）。值得注意的是，医院年手术量每增加一例，其围手术期结局在死亡率（p=0.032）、ICU入住率（p=0.002）、急性肾损伤发生率（p=0.029）及住院时长（p<0.001）方面均有显著改善。结论与临床意义：本真实世界数据表明，医院年手术量的增加与围手术期主要并发症发生率的降低显著相关，每增加一例年手术量可带来围手术期结局的持续优化。

原文链接：

Perioperative Outcomes After Radical Nephrectomy with Inferior Vena Cava Thrombectomy