Mp44-02 Quality Improvement Analysis of Functional Results After Partial Nephrectomy Using Novel Methodology

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP44)1 May 2024MP44-02 QUALITY IMPROVEMENT ANALYSIS OF FUNCTIONAL RESULTS AFTER PARTIAL NEPHRECTOMY USING NOVEL METHODOLOGY Akira Kazama, Worapat Attawettayanon, Carlos Munoz-Lopez, Nityam Rath, Kieran Lewi, Eran Maina, Rebecca A. Campbell, Melissa Boumitri, Jihad Kaouk, Georges-Pascal Haber, Samuel Haywood, Nima Almassi, Christopher Weight, and Steven C. Campbell Akira KazamaAkira Kazama , Worapat AttawettayanonWorapat Attawettayanon , Carlos Munoz-LopezCarlos Munoz-Lopez , Nityam RathNityam Rath , Kieran LewiKieran Lewi , Eran MainaEran Maina , Rebecca A. CampbellRebecca A. Campbell , Melissa BoumitriMelissa Boumitri , Jihad KaoukJihad Kaouk , Georges-Pascal HaberGeorges-Pascal Haber , Samuel HaywoodSamuel Haywood , Nima AlmassiNima Almassi , Christopher WeightChristopher Weight , and Steven C. CampbellSteven C. Campbell View All Author Informationhttps://doi.org/10.1097/01.JU.0001009508.69111.d0.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To perform a quality improvement (QI) evaluation of ipsilateral functional outcomes after partial nephrectomy (PN) using improved methods for measuring parenchymal volumes and estimating split-renal-function (SRF). METHODS: All 894 patients managed with PN with available studies (2011-2014) were evaluated. Percent parenchymal volume preserved (PPVP) was measured from cross-sectional imaging≤3 months before and 3–12 months after PN using novel semiautomated software that is more objective than previous methods. Recovery-from-ischemia (Recischemia) was defined as percent ipsilateral glomerular filtration rate (GFR) preserved normalized by PPVP. Predictors of threshold values of ipsilateral PPVP≥80% and Recischemia≥90% were evaluated using multivariable analyses (MVA). Pearson correlation was used to assess relationships between continuous variables. RESULTS: Median tumor size was 3.4 cm, median R.E.N.A.L. was 7, and 49 patients (5.5%) had a solitary kidney. The initial QI evaluation using previously proposed quality threshold values of PPVP≥80% and Recischemia≥80% showed that only 34 patients (4%) had suboptimal Recischemia, in contrast to 330 patients (37%) with suboptimal PPVP. Subsequent analyses utilized thresholds of PPVP≥80% and Recischemia≥90%, for which 226 patients (25%) had suboptimal Recischemia. MVA demonstrated that greater tumor size and complexity associated with suboptimal PPVP (<80%)(p<0.01), while solitary kidney and cold ischemia associated with satisfactory PPVP (p<0.05). Ischemia time and acute-ipsilateral-renal-dysfunction associated with suboptimal Recischemia (<90%)(p<0.05), while hypothermia associated with satisfactory Recischemia (p<0.01). Extreme suboptimal functional outcomes (percent ipsilateral GFR preserved<60%) occurred in 68 patients (7.6%), mostly related to suboptimal PPVP, which was primarily related to tumor factors (32%) or suboptimal surgical precision (44%). CONCLUSIONS: Suboptimal PPVP is the predominant source of functional decline after PN, although suboptimal Recischemia can also contribute. Tumor related factors can strongly influence PPVP, while surgical precision can improve PPVP as observed for patients with solitary kidneys. Our study identifies multiple opportunities for quality improvement. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e730 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Akira Kazama More articles by this author Worapat Attawettayanon More articles by this author Carlos Munoz-Lopez More articles by this author Nityam Rath More articles by this author Kieran Lewi More articles by this author Eran Maina More articles by this author Rebecca A. Campbell More articles by this author Melissa Boumitri More articles by this author Jihad Kaouk More articles by this author Georges-Pascal Haber More articles by this author Samuel Haywood More articles by this author Nima Almassi More articles by this author Christopher Weight More articles by this author Steven C. Campbell More articles by this author Expand All Advertisement PDF downloadLoading ...