Risk of Postoperative Renal Failure in Radical Nephrectomy and Nephroureterectomy: A Validated Risk Prediction Model
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S. Karger AG
Abstract
Introduction: The study aimed to construct and validate a risk prediction model for incidence of postoperative renal failure (PORF) following radical nephrectomy and nephroureterectomy. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2005-2014 were used for the derivation cohort. A stepwise multivariate logistic regression analysis was conducted, and the final model was validated with an independent cohort from the ACS-NSQIP database years 2015-2017. Results: In cohort of 14,519 patients, 296 (2.0%) developed PORF. The final 9-factor model included age, gender, diabetes, hypertension, BMI, preoperative creatinine, hematocrit, platelet count, and surgical approach. Model receiver-operator curve analysis provided a C-statistic of 0.79 (0.77, 0.82; p < 0.001), and overall calibration testing R2 was 0.99. Model performance in the validation cohort provided a C-statistic of 0.79 (0.76, 0.81; p < 0.001). Conclusion: PORF is a known risk factor for chronic kidney disease and cardiovascular morbidity, and is a common occurrence after unilateral kidney removal. The authors propose a robust and validated risk prediction model to aid in identification of high-risk patients and optimization of perioperative care. © 2022 S. Karger AG. All rights reserved.
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Acute kidney injury, Kidney neoplasms, Logistic models, Minimally invasive surgical procedures, Nephrectomy, Humans, Nephroureterectomy, Postoperative complications, Renal insufficiency, chronic, Retrospective studies, Risk assessment, Risk factors, Creatinine, Acute kidney failure, Adult, Age, Aged, Article, Body mass, Calibration, Cohort analysis, Controlled study, Creatinine blood level, Diabetes mellitus, Female, Gender, Hematocrit, Human, Incidence, Kidney failure, Kidney tumor, Major clinical study, Male, Middle aged, Minimally invasive surgery, Multivariate logistic regression analysis, Outcome assessment, Patient care, Patient risk, Personalized medicine, Platelet count, Postoperative complication, Prediction, Preoperative evaluation, Radical nephrectomy, Receiver operating characteristic, Retrospective study, Risk factor, Risk prediction model, Statistical model, Surgical approach, Validation study, Adverse event, Chronic kidney failure, Complication