To characterize hospital complications following radical nephrectomy (RN) for renal cell carcinoma (RCC) with inferior vena cava (IVC) and cardiac venous tumor thrombectomy (VTT) and evaluate the relationship between hospital caseload and patient outcomes.

A pooled, cross-sectional analysis was conducted using data from the 2016-2020 National Inpatient Sample (NIS) database. Patients undergoing RN for RCC with IVC- or cardiac-VTT were identified, and complications were categorized using an approximation of the Clavien system. Hospital caseload (annual hospital caseload) was classified based on the number of RN procedures with VTT performed annually. Multivariable logistic regression models were used to examine the association between annual hospital caseload, patient characteristics, and complication rates.

Among 111,785 RN cases, 3.3% had IVC-VTT and 0.3% had cardiac-VTT. Major complications occurred in 16.0% of IVC-VTT cases and 43.3% of cardiac-VTT cases, which was significantly higher than for RN without VTT (8.9%). In-hospital mortality was similarly higher with 3.1% occurring for IVC-VTT and 8.3% for cardiac-VTT. Annual hospital caseload was inversely associated with major complications; hospitals performing over 20 such procedures annually had a lower complication rate (4%) compared to those performing fewer than 5 (19%, P < .01). Multivariable analysis confirmed that higher caseload was associated with fewer complications (OR 0.56, P = .01).

RN for RCC with IVC and cardiac VTT is associated with significant complications, especially at lower caseload hospitals. This study suggests that centralization of care to high-caseload centers may improve outcomes for these complex cases. Further research is needed to understand the mechanisms behind this relationship and optimize care delivery systems.