Analysing peri-operative nephrectomy mortality in the older urological population: an Australian and New Zealand Audit of Surgical Mortality (ANZASM) study.

Abstract

Introduction & Objectives: Nephrectomies are performed for various indications including radical nephrectomy for large high-risk renal tumours, partial nephrectomy for small renal masses and renal function preservation, cytoreductive nephrectomy for metastatic renal cancer, or simple nephrectomy for non-functioning kidneys. Faced with an aging population, operations are increasingly being performed on older people. We aim to determine the risk factors and causes of peri-operative mortality in patients aged over 75 undergoing nephrectomy. Method(s): All urological peri-operative deaths in patients aged over 75 were extracted from the ANZASM database from January 2009 to December 2022. All non-nephrectomy deaths were excluded. We analysed patient demographics, duration of hospital stay, procedures, diagnosis, ASA score, underlying comorbidities, complications and cause of death. Result(s): 32 patients died postnephrectomy, which accounts for 2.2% (32/1424) of deaths from this older urological patient cohort. The median age was 81 years. There were 26 elective and five emergency nephrectomy cases documented. There were 27 radical and simple nephrectomies, and 5 partial nephrectomies. Twenty-six patients (81%) had an ASA score of three or higher. Cardiorespiratory comorbidities were the most common seen in 12 patients. Complications included four with tissue ischaemia, three with procedure related sepsis, one significant post-operative bleeding and ten as "other" complications. Causes of death included five pneumonia, four ischaemic bowel, three cardiac arrest, two gastric bleeding, two multiorgan failure, two sepsis, and others including pulmonary embolus, arrhythmia, respiratory failure, chronic renal failure, bowel perforation, intra- and post-operative haemorrhage, intracranial haemorrhage and stroke. Conclusion(s): Age is a risk factor for morbidity and mortality in nephrectomy patients. We found that nearly half had at least one major comorbidity and the majority were greater than ASA three. Many of the complications and causes of death were disease processes that would have better prognoses if detected and managed earlier. The mortality rate among geriatric patients in our study is approximately three times higher compared to the general population.