Does Mechanical Bowel Preparation Improve Quality of Laparoscopic Nephrectomy? Propensity Score-matched Analysis in Japanese Series - 27/12/12
, Hideo Yasunaga c, Hiromasa Horiguchi c, Tetsuya Fujimura b, Hiroaki Nishimatsu b, Kazuhiko Ohe d, Shinya Matsuda e, Kiyohide Fushimi f, Michael W. Kattan g, Yukio Homma b
Reprint requests: Toru Sugihara, M.D., Department of Urology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 Japan.Abstract |
Objective |
To assess the effect of mechanical bowel preparation (MBP) before laparoscopic nephrectomy in terms of operation time and perioperative complications.
Materials and Methods |
Patients undergoing laparoscopic nephrectomy for T1-T3 tumors were identified in the Japanese Diagnosis Procedure Combination database from 2008 to 2010. The patients were stratified into a preoperative MBP group (polyethylene glycol electrolyte, magnesium citrate solution, and sodium picosulfate) and a non-MBP group and were matched using one-to-one propensity score matching according to age, sex, Charlson score, T category, hospital volume, and hospital academic status. The operation time, postoperative length of stay, and overall complication rate were assessed by multivariate regression analyses.
Results |
Of 2740 patients in 355 hospitals, 1110 pairs were generated. The median operation time, postoperative stay, and overall complication rate (MBP vs non-MBP group) was 278 and 268 minutes (P <.004), 10.3 and 10.0 days (P = .695), and 11.8% and 11.4% (P = .740), respectively. The multivariate regression analyses did not find significant superiority of MBP for the 3 endpoints (all P >.05). A shorter operation time was significantly associated with female sex and early-stage tumor. Older age, greater Charlson score, and lower hospital volume adversely affected the postoperative stay and overall complication rate. Stage T3 tumor was unfavorable for the postoperative stay.
Conclusion |
Our large-scale propensity score-matched analysis did not demonstrate a benefit for MBP in operation time, postoperative stay, or overall complications. The results suggest that MBP can be safely omitted before laparoscopic nephrectomy for T1-T3 tumors.
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| Financial Disclosure: The authors declare that they have no relevant financial interests. |
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| Funding Support: This study was funded by a Grant-in-Aid for Research on Policy Planning and Evaluation from the Ministry of Health, Labour and Welfare, Japan (grant H22-Policy-031), by a Grant-in-Aid for Scientific Research B (grant 22390131) from the Ministry of Education and Science, and the Funding Program for World-Leading Innovative Research and Development on Science and Technology (FIRST program) from the Council for Science and Technology Policy, Japan (grant 0301002001001). |
Vol 81 - N° 1
P. 74-79 - janvier 2013 Retour au numéro
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