NEPHRECTOMY AUDIT. OCTOBER 1998-SEPTEMBER 2005 Dr. Sanjeev Bandi MBBS., FRCSI., FRACS(Urology) Mater Misericordiae Hospital, Mackay, Qld 4740
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1 NEPHRECTOMY AUDIT OCTOBER 1998-SEPTEMBER 2005 Dr. Sanjeev Bandi MBBS., FRCSI., FRACS(Urology) Mater Misericordiae Hospital, Mackay, Qld 4740 This audit has been performed in conjunction with the data requirements of the Urological Society of Australasia, the Royal Australasian College of Surgeons and the Australian Council of Health Care Standards (ACHS) Presented at the Northern Section Meeting of the Urological Society of Australasia and submitted for presentation at the AUA in /13/2014 S Bandi, Mackay. AUSTRALIA. 1
2 NEPHRECTOMY AUDIT OCTOBER 1998-SEPTEMBER 2005 Single urologist Epidural/GA Retroperitoneal / Transperitoneal approach Antibiotics as required Bowel preparation/iv hydration Intermittent calf compression Sodium Heparin 5000 units bd (in arm only) as DVT prophylaxis 5/13/2014 S Bandi, Mackay. AUSTRALIA. 2
3 NEPHRECTOMY AUDIT CRITERIA OCTOBER 1998-SEPTEMBER 2005 Patient weight and Body Habitus Operating time Length Of Stay (LOS) % of patients requiring blood transfusions Unplanned readmissions Histology Complications 5/13/2014 S Bandi, Mackay. AUSTRALIA. 3
4 Patient Weight Total weight of all patients/total number of patients This gives an indication of patient s body habitus and ease of surgery 5/13/2014 S Bandi, Mackay. AUSTRALIA. 4
5 Operating Time is a Measure of the Efficiency of the Surgery Skin preparation to skin closure Average Operating time 5/13/2014 S Bandi, Mackay. AUSTRALIA. 5
6 Length of Stay (LOS) Is a Measure of Resource Utilisation Involved With This Procedure Day of surgery=day 0 No:of patient days for all Nephrectomy patients/ total no:of patients (excluding patients having other procedures) 5/13/2014 S Bandi, Mackay. AUSTRALIA. 6
7 Percentage of Patients Requiring Blood Transfusions Transfusions: Pre/Intra/Post operatively within the same admission 5/13/2014 S Bandi, Mackay. AUSTRALIA. 7
8 Unplanned Readmission Unplanned readmission within 28 days of discharge following Nephrectomy 5/13/2014 S Bandi, Mackay. AUSTRALIA. 8
9 Patient weight and Body Habitus Patient Weight Chart Weight in kg MALE FEMALE No:of Patients Average weight of 61 patients who underwent a Nephrectomy: 81.15kg. Range was from kg Males 36 Females 25 5/13/2014 S Bandi, Mackay. AUSTRALIA. 9
10 Operating Time is a Measure of the Efficiency of the Surgery Average operating time in minutes for 34 Radical Nephrectomies: 205 minutes This includes 4 cases with renal vein thrombus and 6 patients with multiple tumours in same kidney Excluding the above the Average operating time in minutes was 181 minutes Operating Time Time in minutes Male Female No:of Patients 5/13/2014 S Bandi, Mackay. AUSTRALIA. 10
11 Operating Time is a Measure of the Efficiency of the Surgery Average operating time in minutes for 6 Partial Nephrectomies:181 minutes Operating Time Time in mins Male Female No:of Patients 5/13/2014 S Bandi, Mackay. AUSTRALIA. 11
12 Operating Time is a Measure of the Efficiency of the Surgery Average operating time in minutes for 10 Simple/Complete Nephrectomies:162.5 minutes Operating Time Time in Mins Female Male No:of Patients 5/13/2014 S Bandi, Mackay. AUSTRALIA. 12
13 Operating Time is a Measure of the Efficiency of the Surgery Average operating time in minutes in 11 Nephroureterectomies: minutes Operating Time Time in Mins Male Female No:of Patients 5/13/2014 S Bandi, Mackay. AUSTRALIA. 13
14 Length of Stay (LOS) Is a Measure of Resource Utilisation Involved With This Procedure Average LOS in 34 patients who underwent Radical Nephrectomy: 4.15 days If 2 patients who had LOS of 9 and 13 days were excluded the LOS dropped to 3.71 days (DRG LO3B 6.7 days and DRG LO3A 13.4 days) Length of Stay (LOS) No:of Patients Patients No:of Days 5/13/2014 S Bandi, Mackay. AUSTRALIA. 14
15 Length of Stay (LOS) Is a Measure of Resource Utilisation Involved With This Procedure Average LOS in 6 patients who had a Partial Nephrectomy: 6.16 days (DRG LO3B 6.7 days DRG LO3A 13.4 days) Length of Stay (LOS) No:of Patients Patients No:of Days 5/13/2014 S Bandi, Mackay. AUSTRALIA. 15
16 Length of Stay (LOS) Is a Measure of Resource Utilisation Involved With This Procedure Average LOS in 11 patients who underwent Nephroureterectomy: 5.91 days (DRG LO3B 6.7 days DRG LO3A 13.4 days) Length of Stay (LOS) No:of Patients Patients No:of Days 5/13/2014 S Bandi, Mackay. AUSTRALIA. 16
17 Length of Stay (LOS) Is a Measure of Resource Utilisation Involved With This Procedure Average LOS in 10 patients who underwent Simple Complete Nephrectomy:3.33 days (DRG LO3B 6.7days and DRG LO3A 13.4 days) 1 exclusion who had excision of tail of pancreas and drainage of perinephric abscess in a diabetic with NF kidney and XGP secondary to staghorn calculus who presented with urosepsis Length of Stay(LOS) No:of Patients Patients No:of Days 5/13/2014 S Bandi, Mackay. AUSTRALIA. 17
18 Size of Renal Carcinomas removed Average size of renal tumour removed in 32 patients : 4.91 centimetres 2 Radical Nephrectomies for Renal Calyceal and Pelvic TCC Range centimetres 5/13/2014 S Bandi, Mackay. AUSTRALIA. 18
19 Percentage of Patients Requiring Blood Transfusions 9/61 patients: 14.75% 4 RCC with renal vein involvement had autologous blood, 2 patients after partial nephrectomy, 1 pre op anaemic patient with DM,XGP and perinephric abscess, 2 with anaemia and multifocal TCC of bladder and kidney. Total no:of units transfused 28(1,2,2,2,3,4,4,5,5) 5/13/2014 S Bandi, Mackay. AUSTRALIA. 19
20 UNPLANNED READMISSIONS/REOPERATIONS 1 re operation to drain retroperitoneal collection at 34 days Left Nephrectomy, Adrenaleectomy & Excision of Tail of Pancreas for kidney with XGP. Diabetic with Urosepsis and NF kidney with staghorn calculus and perinephric abscess Weight 98kg Height 162 cms(5ft 1in) Age 62 LOS 53 days 5/13/2014 S Bandi, Mackay. AUSTRALIA. 20
21 PATHOLOGY Renal Cell Carcinomas : 32 Clear cell 20 Multifocal/Papillary 7 Sarcomatoid 3 Chromophobe 2 Transitional Cell Carcinomas of Renal Pelvis/calyces and Ureter 11 Angiomyolipomas 1 Oncocytomas 3 Chronic Pyelonephritis 10 Xanthogranulomatous Pyelonephritis (XGP) 3 Hamartoma of renal vasculature 1 5/13/2014 S Bandi, Mackay. AUSTRALIA. 21
22 Complications No deaths No pulmonary emboli No Hospital acquired bacteraemia 1 Profuse diarrhoea from Ural sachets(pre existing IBS) LOS 10 days 1 subcutaneous emphysema secondary to rib # s caused by Finochetti retractor in 78yr old male ( LOS 13days) Nursing home resident 1 patient had an AMI post op requiring extended stay in hospital( LOS 10days) 5/13/2014 S Bandi, Mackay. AUSTRALIA. 22
23 Complications 2 2 loin hernias, 1 required surgery. 1 recurrent retroperitoneal tumour recurrence 11 months post op in spite of clear margins and 5 lymph nodes clear of disease 1 Sevoflurane induced hepatitis causing nausea and malaise (LOS 4 days) 1 CVA 72 hours after a Lt Radical Nephrectomy for multifocal(3) Papillary/Chromophil Renal carcinomas secondary to a bleed in the mid brain (LOS 9 DAYS) 5/13/2014 S Bandi, Mackay. AUSTRALIA. 23
24 Complications 3 1 patient aged 66 Lt Radical Nephrectomy for 9.5cm Clear cell carcinoma pt3b. Tumour thrombi in renal veins noted on HPE. Uneventful recovery. LOS 4 days Pleuritic chest pain and DVT Lt leg below knee 32 days post op. CTPA: No PE but extensive lymphadenopathy and 2.8cm Rt lower lobe mass. Pre Op CXR was normal. Action Point: CT CHEST IN LARGE TUMOURS > 5CMS 5/13/2014 S Bandi, Mackay. AUSTRALIA. 24
25 Complications 4 1 patient developed Guillain- Barre syndrome type paresis with weakness in lower limbs 5 weeks after surgery for Renal Carcinoma with renal vein involvement. Known diabetic with chronic renal impairment and hypertension and morbid obesity(130kg) 5/13/2014 S Bandi, Mackay. AUSTRALIA. 25
26 ACKNOWLEDGEMENTS Ms Gail Van Moolenbrook and Ms Margaret Chetcuti at the Medical Records Department at the Mater Hospital in Mackay. Vignesh Bandi for teaching me to use Microsoft Excel. A follow up study with 10 year survival data is planned. 5/13/2014 S Bandi, Mackay. AUSTRALIA. 26
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