• Behroz Firoozfard, Tom H Christensen, Anette Bendixen, Jørgen Nordling, and Henrik Kehlet.
• Sundhedsstyrelsen, Center for Evaluering og Medicinsk Teknologivurdering (CEMTV), H:S Rigshospitalet, Urologisk Afdeling, København S.
• Ugeskr. Laeg. 2006 Apr 10; 168 (15): 1526-8.

IntroductionImplementation of principles of fast-track surgery as well as laparoscopy may decrease hospital stay after nephrectomy to about 2-4 days. The aim of this study was to analyse the incidence, use of laparoscopic vs. open nephrectomy, hospital stay, morbidity and mortality in Danish hospitals within the period 2002-2005.MethodsExtraction of information from the National Patient Register (LPR) and discharge notes from Jan. 1 2002 to Dec. 31 2004.ResultsIn the 3-year period, 1968 nephrectomies were performed in a total of 45 departments, decreasing to 29 departments in 2004. Five departments performed > 100 operations during the 3 years, 10 departments performed between 50-100 operations and 30 departments <50 operations during the 3 years. The average length of hospital stay (primary and readmission) was 9.1 days. The total mortality rate was 2.2%; lower (1.5%) in departments with high activity vs. departments with low activity (4.3%, p < 0.01). Laparoscopic surgery was performed in 11 departments with a hospital stay of 5.2 vs. 9.5 days and with fewer surgical and medical complications and mortality (0.4% vs. 2.5%), compared with open operation.ConclusionThe organisation and results after nephrectomy are not optimal on a nationwide basis. This precludes further optimisation of the early perioperative results, including use of the laparoscopic approach combined with the principles of fast-track surgery. It is suggested that nephrectomy in the future is performed in fewer departments to fulfil these needs.

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