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Comparisons of postoperative outcomes after breast cancer surgery in patients with and without renal replacement therapy: a matched-pair cohort study using a Japanese nationwide inpatient database

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Abstract

Background

Although patients receiving renal replacement therapy (RRT) have more comorbidities and higher mortality and morbidity risks than the general population, surgery during breast cancer treatment is crucial because of limitations in anticancer agents for patients with renal insufficiency. We aimed to compare the short-term postoperative outcomes between patients with and without RRT.

Methods

Patients who underwent surgery for stages 0–III breast cancer between July 2010 and March 2017 were retrospectively identified in a Japanese nationwide inpatient database and divided into those with RRT (RRT group, n = 1547) and those without RRT (control group, n = 364,047). We generated a 1:4 matched-pair cohort matched for age, institution, and fiscal year at admission. We conducted multivariable regression analyses to compare postoperative complications, 30-day readmission, and anesthesia duration between the two groups.

Results

The RRT group was more likely to have comorbidities (95.0% vs. 24.1%) and undergo total mastectomy (64.2% vs. 47.0%) than the control group. The RRT group was not significantly associated with complications (odds ratio 1.18; 95% confidence interval [CI] 0.89–1.56) and 30-day readmission (odds ratio 0.88; 95% CI 0.65–1.18), but was associated with shorter anesthesia duration (difference, − 6.8 min; 95% CI − 10.7 to − 3.0 min) compared with the control group.

Conclusions

The matched-pair cohort analyses revealed no significant differences in postoperative complications after breast cancer surgery between patients with and without RRT. Breast cancer surgery in patients with RRT may be as safe as that in patients without RRT, if comorbidities other than chronic renal failure are adequately addressed.

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Acknowledgements

This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and 20AA2005), and the Ministry of Education, Culture, Sports, Science and Technology, Japan (20H03907).

Author information

Authors and Affiliations

  1. Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Takaaki Konishi, Masahiko Tanabe & Yasuyuki Seto

  2. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Takaaki Konishi, Michimasa Fujiogi, Kojiro Morita, Hiroki Matsui & Hideo Yasunaga

  3. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA

    Michimasa Fujiogi

  4. Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Nobuaki Michihata

  5. Department of Health Services, Faculty of Medicine, University of Tsukuba, 1-1-1 Ten-nodai, Tsukuba, Ibaraki, 305-8577, Japan

    Kojiro Morita

  6. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan

    Kiyohide Fushimi

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  1. Takaaki Konishi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by KM, HM, and KF. The statistical analysis was carried out by TK, MF, and NM. The first draft of the manuscript was written by TK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Takaaki Konishi.

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All authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board at The University of Tokyo and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

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The need for informed consent in the present study was waived because of the anonymity of the patient database.

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Konishi, T., Fujiogi, M., Michihata, N. et al. Comparisons of postoperative outcomes after breast cancer surgery in patients with and without renal replacement therapy: a matched-pair cohort study using a Japanese nationwide inpatient database. Breast Cancer 28, 1112–1119 (2021). https://doi.org/10.1007/s12282-021-01248-7

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