Predictors of bleeding requiring transfusion following partial nephrectomy: an analysis of the ACS-NSQIP database.

Partial nephrectomy (PN) has been established as the standard treatment for T1 kidney tumors, and postoperative hemorrhage has been reported as a potentially life-threatening complication.PurposeTo estimate the risk of bleeding requiring blood transfusion using patient characteristics in order to risk-stratify patients preoperatively and identify patients at high risk of bleeding following PN. We also aim to quantify the effect of this bleeding complication on postoperative morbidity and mortality.Materials and methodsThe demographics, associated co-morbidities, and some pre-operative variables, operation characteristics and baseline laboratory values were examined in 23,257 patients undergoing PN in the American College of Surgeons - National Surgical Quality of Improvement Program (ACS-NSQIP) dataset from 2005 to 2017. We divided our cohort into two groups based on the requirement of a blood transfusion post-operation. Multivariable logistic regression was done to evaluate pre-operative variables associated with post-operative transfusion. The secondary outcome was analyzed, using Chi-square and student t-test, to compare post-operative morbidities and mortality between groups.ResultsOf the 23,257 patients who underwent partial nephrectomy (PN), 1,287 (5.5%) experienced postoperative hemorrhage requiring transfusion. Univariate analysis revealed significant differences between the hemorrhage and non-hemorrhage groups with respect to age, race, body mass index, comorbidities, ASA class, surgical approach, year of operation, and baseline laboratory values. However, on multivariate analysis, only older age, open surgical approach, presence of a bleeding disorder, having received preoperative transfusions, higher preoperative blood urea nitrogen (BUN), lower serum albumin, lower hematocrit, and prolonged partial thromboplastin time (PTT) were independently associated with an increased risk of postoperative hemorrhage. Furthermore, patients who experienced hemorrhage had significantly higher rates of other postoperative complications compared to those who did not.ConclusionsAccurate estimation of bleeding risk is critical for decision making and informed consent prior to PN, especially given the demonstrated impact on morbidity and mortality of this complication. A risk calculator is a helpful tool to help minimize the occurrence of this complication.