NEW ORLEANS, LA USA (UroToday.com) - In this study, our group looked to assess the ability of 3 different metrics to predict patients at risk for postoperative morbidity and mortality following renal mass excision. The 3 metrics utilized were the Surgical Apgar Score (SAS), Nephrometry score (NS) and Charlson Comorbidity Index (CCI). The SAS is a measure validated in general and vascular surgery cohorts to predict patients at higher risk for postoperative morbidity and mortality. It is comprised of 3 components: estimated blood loss, lowest heart rate, and lowest mean arterial pressure. For each component a point value is assigned, and the sum of the components provides a score ranging from 0 to 10, which is inversely correlated with postoperative complications.

For the study our group extracted data from a prospectively collected IRB-approved database of patients undergoing partial or radical nephrectomy between 2010 and 2013. The final study cohort consisted of 886 patients. In total, 13.2% of the patients experienced major complications. Ninety-day mortality was 1.4%. Patients experiencing complications had a significantly lower mean SAS (7.3 vs 7.8 for those without complications, p=0.004) and a significantly higher mean NS (8.8 vs 8.0, p=0.0001) and mean CCI (1.7 vs 1.2, p=0.003). Patients experiencing complications were also older and more likely to have undergone open surgery. Patients dying within 90 days of surgery had a significantly lower mean SAS (6.3 vs 7.7, p=0.03). On multivariable analysis controlling for age and surgery type, our group found that a CCI ? 1 and a NS ? 8 were independent predictors of major complications. A SAS ? 4 was associated with a 15-fold increased risk of 90-day mortality. In addition our group found that each 3 point decrease in the SAS corresponded to one extra day in the hospital postoperatively.

Based on these findings, our group concluded that the SAS, NS and CCI are simply collected metrics that can identify patients at higher risk for adverse events following renal mass excision. Further validation of these measures will help to further delineate optimal utilization of these tools in an adjusted, perioperative management approach to patients undergoing complex renal mass excision.

Presented and reported by Timothy Ito, MD at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA

Fox Chase Cancer Center, Philadelphia, PA USA

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