Perioperative outcomes of primary renal tumour resections: comparison of in-hours to out-of-hours surgery

• Published in: Pediatric surgery international Vol. 30; no. 10; pp. 1003 - 1007
• Main Authors: Forbes, Connor, Butterworth, Sonia A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2014; Springer Nature B.V
• Subjects: After-Hours Care - methods; After-Hours Care - statistics & numerical data; British Columbia - epidemiology; Child, Preschool; Cohort Studies; Female; Humans; Intraoperative Complications - epidemiology; Kidney - surgery; Kidney Neoplasms - epidemiology; Kidney Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Nephrectomy - methods; Original Article; Pediatric Surgery; Pediatrics; Postoperative Complications - epidemiology; Retrospective Studies; Surgery; Treatment Outcome; Wilms Tumor - surgery; British Columbia; Wilms tumour; Out-of-hours; Complications; Paediatrics; Paediatric oncology
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s00383-014-3560-4

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.