International Urology and Nephrology

, Volume 51, Issue 9, pp 1481–1489 | Cite as

Is there a benefit to additional neuroaxial anesthesia in open nephrectomy? A prospective NSQIP propensity score analysis

  • Amr Mahran
  • Kirtishri Mishra
  • Danly Omil-Lima
  • Bissan Abboud
  • Michael Wang
  • Jason Jankowski
  • Robert Abouassaly
  • Lee Ponsky
  • Irma Lengu
  • Laura BukavinaEmail author
Urology - Original Paper



Neuroaxial (i.e., spinal, regional, epidural) anesthesia has been shown to be associated with reduced readmission rate, decreased hospital stay, and decreased overall complication rate in orthopedic and gynecologic surgery. Our aim was to identify differences in intra- and postoperative complications, length of stay and readmission rates in open nephrectomy patients managed with neuroaxial anesthesia.

Materials and methods

Utilizing National Surgical Quality Inpatient Program (NSQIP) database, we identified patients who have undergone an open nephrectomy between 2014 and 2017. Patients were further subdivided based on anesthesia modality. We used the propensity score-matching (PSM) method to adjust for baseline differences among patients who received general anesthesia alone and those with additional neuroaxial anesthesia. Using step-wise multivariable logistic regression, we identified preoperative and intraoperative predictors associated with 30-day procedure-related readmission, complications, and postoperative length of stay.


Out of 3,633 patients identified, 2346 patients met our inclusion and exclusion criteria. There was no difference in baseline characteristics after propensity score matching between general and additional neuroaxial anesthesia. Postoperative outcomes including: procedure-related readmission, rate of reoperation, operative time, all complications were similar between the groups. Adjuvant neuroaxial anesthesia group did experience a prolonged postoperative hospital stay that was statistically significant as compared to patients with general anesthesia alone [5.3 (3.5) days vs 4.8 (2.9) days, p = 0.007].

Compared to GA alone after multivariable logistic regression, neuroaxial anesthesia was not statistically significant for readmission (p = 0.909), any complication (p = 0.505), but did showed increased odds ratio of prolonged postoperative stay [aOR 1.107, 95% CI 1.042–1.176, p = 0.001] after adjusting for multiple factors.


Using 2014–2017 NSQIP database, we were able to demonstrate no additional reduction in complication or readmission rate in patients with neuroaxial anesthesia as compared to general anesthesia alone. Furthermore, patients who did receive neuroaxial anesthesia experienced a longer postoperative course.


Renal cell Kidney cancer Neuroaxial anesthesia 



Enhanced recovery after surgery


National Institute of Health and Care Excellence


Adjusted odds ratio


Regional block


American Society of Anesthesiology


Deep-vein thrombosis


Venous thromboembolism


Neuroaxial anesthesia


Current procedural terminology


National Surgical Quality Improvement Program




Compliance with ethical standards

Conflict of interest

All the authors declare that he/she have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Supplementary material

11255_2019_2208_MOESM1_ESM.docx (124 kb)
Supplementary file1 (DOCX 124 kb)
11255_2019_2208_MOESM2_ESM.docx (52 kb)
Supplementary file2 (DOCX 52 kb)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Amr Mahran
    • 1
    • 2
  • Kirtishri Mishra
    • 2
  • Danly Omil-Lima
    • 2
  • Bissan Abboud
    • 2
  • Michael Wang
    • 1
    • 2
  • Jason Jankowski
    • 2
    • 3
  • Robert Abouassaly
    • 4
    • 5
  • Lee Ponsky
    • 2
    • 3
  • Irma Lengu
    • 6
  • Laura Bukavina
    • 2
    Email author
  1. 1.Case Western Reserve University School of MedicineClevelandUSA
  2. 2.Urology Institute, University Hospitals Cleveland Medical CenterCase Western Reserve University School of MedicineClevelandUSA
  3. 3.Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandUSA
  4. 4.Glickman Urology and Kidney InstituteCleveland ClinicClevelandUSA
  5. 5.Louis Stokes Cleveland VA Medical CenterClevelandUSA
  6. 6.Metro Health Medical CenterClevelandUSA

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