Abstract
Purpose
Primary resection is typically performed for children with localised suspected Wilms tumours. Resource limitation may necessitate performing these operations nights and weekends. We hypothesise that outcomes will be worse in patients having nephrectomies out-of-hours (OOH) compared to those in-hours (IH).
Methods
With IRB ethics approval, primary renal tumour resections performed on oncology patients from 1989–2011 were reviewed retrospectively. IH operations were defined as Monday–Friday 0745–1530 hours. Outcomes included major intraoperative complications, capsule rupture, and blood loss. Data were analysed using Fischer Exact and Mann–Whitney U tests.
Results
There were 64 patients with renal tumours who underwent primary resection. Forty-five procedures were performed IH, and 19 OOH. Groups were similar in age, ASA status, tumour size and grade. In a comparison of major intraoperative complications, capsule rupture, and mean blood loss, differences were 2 vs. 26 % (p = 0.007), 27 vs. 42 % (p = 0.12), 178 vs. 244 ml (p = 0.15) for IH and OOH respectively. There was one perioperative mortality (OOH).
Conclusions
Primary renal tumour resections performed OOH were associated with an increase in major complications compared to those performed in standard hours. Avoidance of OOH operating where possible may reduce morbidity for children undergoing primary renal tumour resections.
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Acknowledgments
The authors would like to thank the Office of Paediatric Surgical Evaluation and Innovation and British Columbia Children’s Hospital for their support for this project.
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None of the authors have any conflict to disclose.
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Forbes, C., Butterworth, S.A. Perioperative outcomes of primary renal tumour resections: comparison of in-hours to out-of-hours surgery. Pediatr Surg Int 30, 1003–1007 (2014). https://doi.org/10.1007/s00383-014-3560-4
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DOI: https://doi.org/10.1007/s00383-014-3560-4