A national approach to benchmarking nephrectomy practice in patients with benign renal disease: an analysis of the British Association of Urologists (BAUS) complex operation registry

Pascoe, J.M., John, J., Fowler, S., Challacombe, B., Narahari, K. ORCID: https://orcid.org/0000-0003-0257-7033, Mcgrath, J.S. and British Association of Urologists Section of Oncology 2020. A national approach to benchmarking nephrectomy practice in patients with benign renal disease: an analysis of the British Association of Urologists (BAUS) complex operation registry. European Urology Open Science 19 (Supple) , e711. 10.1016/S2666-1683(20)33053-6

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Abstract

Introduction & Objectives: Since 2012 it has been mandatory for urologists to enter data on patients undergoing a nephrectomy in to the BAUS complex operation register. This allows in depth analysis describing UK practice and outcomes. Here we present on of the largest series of patients undergoing a nephrectomy for benign disease. Our objective is to produce detailed bench marking data for benign nephrectomy, facilitating transparency and a reference tool for surgeons. Materials & Methods: BAUS manage a complex operations database for all nephrectomy. 161 data fields are uploaded by surgical departments, pertaining to patient, disease, surgical, pathological and outcome descriptors. There are two opportunities for surgeons to review and amend their data before lock-down and data cleansing. Analysis of 2016-18 data was performed for 3259 patients undergoing nephrectomy for benign renal disease in England. Results: Using HES data for comparison, completion rate was estimated at 91.3%. Benign nephrectomy was performed in 293 centres by 180 consultants. Median number performed in 3 years by consultant and centre was 7 and 14 respectively. Median patient age was 52 and 61.3% were female. Pre-operative presentation varied considerably with haematuria & incidental presentations accounting for 13.2% & 8.9% respectively. Where presentation was categorised as 'other' (73.7%), this was subdivided with 52.1% of these patients presenting with pain & 43.5% of patients presenting with recurrent urinary tract infections. Aetiology included non-functioning kidney (52.3%), stone disease (11.0%), pyelonephritis (5.3%), oncocytoma (1.2%), polycystic disease (2.14%), xanthogranulomatous pyelonephritis (3.3%), and donor nephrectomy (15.9%). Operative technique was minimally invasive in 85.6%, with 2.8% of cases hand-assisted, 76.8% laparoscopic, 13.0% open, and 6.0% robotic-assisted. Overall transfusion rate was 0.1%. Intensive care admission occurred in 9.1% with 86.5% of these admissions being planned for. Median length of stay was 3 days and differed by surgical technique; 4 days for hand assisted, 3 days for laparoscopic, 6 days for open & 2 days in robot-assisted benign nephrectomy. The primary surgeon was a consultant in at least 82.2% with 10.0% of cases classified as training cases. Reported histology was malignant in 3.9% of cases. Post-operative mortality occurred in 12 patients cases (0.4%) following nephrectomy. Conclusions: This comprehensive database of benign nephrectomies performed across England offers a standard for urologists to compare their current practice to, including patient selection, operative techniques & outcomes. Benign nephrectomy is offered across a high number of centres for a variety of indications, and utilising a range of operative techniques. It is a relatively safe procedure, with low mortality and transfusion rates.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Elsevier
ISSN:	2666-1691
Last Modified:	29 Nov 2024 16:30
URI:	https://orca.cardiff.ac.uk/id/eprint/173959

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