Investigating the relationship between preoperative laboratory values and postoperative complications in radical nephrectomy patients.

Philadelphia, PA

INTRODUCTION: Cancer involving the kidney and/or renal pelvis is one of the more frequent causes of cancer in the United States with a prevalence of more than 10 per 100,000. Radical nephrectomy is a common treatment modality for renal cell carcinoma. In an effort to optimize patient safety, many preoperative parameters are used to evaluate and assess a patient's overall health. These include, but are not limited to, patient comorbidities, tumor anatomy, and standard laboratory values. Unfortunately, the literature surrounding these values, among other preoperative laboratory values, in relation to postoperative surgical outcomes is limited. The purpose of this study is to review multiple preoperative labs in effort to identify any associations with increased adverse outcomes in the postoperative period of patients who underwent radical nephrectomy.

METHODS: Data for this study was collected from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. NSQIP data from 2019 and 2020 was looked at for radical nephrectomy patients, producing a study patient population of 9,526. Patient data regarding preoperative laboratory values was organized based on whether the recorded values for each variable fell below, above, or within the normal range. Following categorization of the preoperative laboratory values, incidence of adverse outcomes or complications was investigated. Statistical analysis of the data was done with the Wilcoxon test, which served to compare the mean occurrences of adverse outcomes across the different categories of preoperative laboratory values.

RESULTS: Wilcoxin test showed that patients with low preoperative sodium values had a higher occurrence of unplanned reoperation than patients than with sodium values within normal limits (p=0.0012). Occurrence of unplanned reoperation was also found to be more common in patients with high blood urea nitrogen compared to those with preoperative values within the normal range (p=0.0005), and a similar pattern was found regarding creatinine values (p=0.0068).

DISCUSSION: The data show that preoperative laboratory values may hold significant influence in the occurrence of postoperative complications for patients undergoing radical nephrectomy. Through gaining a deeper understanding of the relationship between preoperative laboratory values and incidence of adverse postoperative events providers may be able to be more prepared to combat complications and make more informed decisions on when to perform a radical nephrectomy based on a patient’s preoperative laboratory values.