Outcomes in patients undergoing nephrectomy for renal cancer on chronic anticoagulation therapy Journal Article

Authors: Sfakianos, J. P.; Hakimi, A. A.; Kim, P. H.; Zabor, E. C.; Mano, R.; Bernstein, M.; Karellas, M.; Russo, P.
Article Title: Outcomes in patients undergoing nephrectomy for renal cancer on chronic anticoagulation therapy
Abstract: Aims To report our experience on surgical resection of renal tumors for patients with a history of chronic anticoagulation (ACT) or aspirin use. Methods We performed a retrospective analysis of 2473 patients who underwent surgery for renal tumors between 2005 and 2012. Prior to surgery, 172 were on chronic ACT and 695 on aspirin. Multivariable linear and logistic regression models were used to compare transfusion and overall complication rates between patients undergoing renal surgery who were on therapy to patients who were on aspirin and to patients with no therapy. Results Compared to no therapy and aspirin patients those on ACT were older (57.3 (IQR 48.4-66.10) vs 63.9, (IQR 57.3-71.5) vs 68.4, (IQR 60.4-73.5); p < 0.001), with a higher percentage having an ASA score of 3 or 4 (42.4 vs 57.9 vs 82.6%; p < 0.001), respectively. ACT patients had a higher 30-day transfusion rate, 22.7% vs 7.6% vs 6.9%, and 90-day complication rate, 17.4% vs 7.2% vs 7.3%, both p < 0.001. The median length of stay differed statistically between groups (p < 0.001), with a modest longer stay in the anticoagulation group (OR 1.11 SE 0.26; p < 0.001). Transfusion and complication rates for patients on therapy undergoing minimally invasive surgery vs open surgery were not statistically different. Conclusions Patients on chronic ACT had higher transfusion and overall complication rates compared to patients on no treatment or on chronic aspirin. These findings did not correlate to clinical differences in length of stay or grade 3-5 complications.
Keywords: adult; aged; major clinical study; outcome assessment; anticoagulant therapy; deep vein thrombosis; retrospective study; kidney neoplasms; nephrectomy; postoperative complication; length of stay; partial nephrectomy; kidney surgery; acetylsalicylic acid; heart infarction; scoring system; anticoagulants; clopidogrel; warfarin; minimally invasive surgery; heart arrhythmia; kidney cancer; postoperative hemorrhage; erythrocyte transfusion; hematoma; enoxaparin; anticoagulant agent; tinzaparin; intraoperative complications; open surgery; human; priority journal; article; chronic anticoagulation therapy
Journal Title: European Journal of Surgical Oncology
Volume: 40
Issue: 12
ISSN: 0748-7983
Publisher: Elsevier Inc.  
Date Published: 2014-12-01
Start Page: 1700
End Page: 1705
Language: English
DOI: 10.1016/j.ejso.2014.04.010
PROVIDER: scopus
PMCID: PMC4208948
PUBMED: 24813810
Notes: Export Date: 2 February 2015 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Paul Russo
    446 Russo
  2. Emily Craig Zabor
    121 Zabor
  3. Philip Hyunwoo Kim
    39 Kim
  4. Abraham Ari Hakimi
    129 Hakimi
  5. Roy Mano
    21 Mano