Warm Ischemic Time > 25 Minutes is a Significant Risk Factor of Hemorrhagic Complication in Patients who Received Robotic Assisted Partial Nephrectomy
Cheng-Han Tsai, Hsiao-Jen Chung, Eric YH Huang, Tzu-Ping Lin, Tzu-Hao Huang, William J. Huang
Department of Urology, Taipei Veterans General Hospital
Department of Urology, School of Medicine and Shu-Tien Urological
Research Center, National Yang-Ming University, Taipei, Taiwan
腎臟缺血時間大於25分鐘為接受機械手臂輔助部分腎切除病患發生出血併發症之危險因子
蔡承翰1、鍾孝仁123、黃逸修123、林子平123、黃子豪123、黃志賢123
台北榮民總醫院泌尿部1, 國立陽明大學 醫學院 泌尿學科2; 書田泌尿科學研究中心3
Purpose
The most frequent and potentially life threatening events associated with partial nephrectomy (PN) are hemorrhagic complications (HC), which may raise morbidity and increase length of hospital stay. The aim of this study was to analysis the risk factors of HC in patients who received robotic assisted partial nephrectomy (RAPN).
Material and method
We retrospectively reviewed medical records of 260 patients who underwent RAPN between January 2010 and July 2018. Patients with renal angiomyolipoma diagnosed by preoperative image study were excluded.
Patient demographics, comorbidities, perioperative outcomes, and complications data were analyzed. HC were defined as bleeding, hematoma or arteriovenous fistula requiring conservative treatment, blood transfusion or therapeutic intervention, which were divided as intraoperative, postoperative and delayed (after hospital discharge) bleeding. The severity of HC was graded according to the Clavien classification system. We investigated whether there is a relevant association between perioperative factors and HC.
Result
Of 260 patients included in this study, 32 (12.3%) patients had HC, which were intraoperative in 16 (6.2%), postoperative in 6 (2.3%) and delayed in 10 (3.8%). As classified by the Clavien system, HC were grade I in 6 (18.8%), grade II in 17 (53.1%), grade IIIa in 8 (25%) and grade IIIb in 1 (3.1%) of cases. No complication-related deaths occurred. In univariate analysis, type 2 DM, RENAL score, console time, warm ischemic time and pedicle control were the statistically significant risk factors. In multivariate logistic regression analysis, warm ischemic time > 25 minutes was the only significant risk factor for HC.
Conclusion
Patients who underwent RAPN with warm ischemic time > 25 minutes correlated significantly with hemorrhagic complications and should be carefully monitored in the postoperative course.