Urology
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To perform a retrospective analysis to determine the operative morbidity in patients with substantial comorbidities requiring renal surgery. Increasing numbers of patients requiring renal surgery are presenting with substantial comorbidities, such as diabetes mellitus, chronic obstructive pulmonary disease, and cardiovascular disease. ⋯ Partial or radical nephrectomy can be offered to patients with comorbid conditions. ASA classification 3 patients are more likely to require transfusion. This may have been a result of a lower threshold to transfuse patients with preoperative morbidities. However, the perioperative and postoperative complication rates were similar to those of low-risk patients. Not surprisingly, high-risk patients had greater rates of transfusions and complications.
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To evaluate the volume-outcome relationship in patients undergoing nephrectomy for neoplastic disease by examining the impact of the number of cases performed on in-hospital mortality and length of stay. Surgical volume is associated with postoperative mortality for many complex procedures; however, this relationship has not been characterized for patients undergoing nephrectomy for neoplastic disease. ⋯ A greater surgical volume, age younger than 65 years, elective conditions, and less comorbidity are associated with a significantly decreased risk of in-hospital mortality after nephrectomy. These findings provide compelling evidence that hospital volume and patient characteristics have important effects on surgical outcome specific to renal neoplasms.