Nephrectomy, Pulmonary Embolism, Renal Cell Carcinoma
Conditions
Brief summary
Patients with renal carcinoma was reported at high incidence of perioperative pulmonary embolism from current study. The investigators aimed to determine the incidence and outcome of this group of patient in the tertiary-care, university hospital and the rate of intraoperative transesophageal echocardiography utility and outcome.
Detailed description
Perioperative pulmonary embolism (PE) is the serious adverse event leading to major morbidity and mortality. The incidence of PE during urologic surgery was previously report at 0.9 - 1.1% with mortality rate less than 2%. But the recent study by Fukazawa et al report the incidence of PE was 11% in renal cancer patients underwent nephrectomy with mortality rate as high as 33%. The risk factors associated with PE included major surgery, cancer, arrhythmia, massive bleeding and level of tumor thrombus in inferior vena cava. Transesophageal echocardiography (TEE) is a very helpful intraoperative monitoring tool in major, non-cardiac surgery to detect emboli and guide the hemodynamic management in severely unstable patients. But it requires sophisticate machine and well-trained operator, the rate of utilisation was still limited. The investigators aimed to determine the incidence of perioperative PE in renal cancer patients undergoing nephrectomy. the secondary outcomes include risk factors associated with perioperative PE, clinical outcomes, the rate of TEE utilization in this operation and outcome.
Interventions
OTHERNephrectomy
Patients underwent nephrectomy
Sponsors
Mahidol University
Study design
Observational model
OTHER
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients with renal cancer undergoing nephrectomy
Exclusion criteria
* Patients with incomplete data
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The incidence of intraoperative PE of renal cancer patient undergoing nephrectomy | intraoperative period | Pulmonary embolism * Clinical suspicious:Systolic blood pressure \< 90 mmHg without other reasonable causes, partial pressure of oxygen in artery \< 80 mmHg * Confirmed diagnosis: intraoperative TEE (direct demonstration of PE or indirect signs of PE), CT angiography, perfusion lung scan |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The incidence of postoperative PE of renal cancer patient undergoing nephrectomy | until 7 days after surgery | Pulmonary embolism * Clinical suspicious:Systolic blood pressure \< 90 mmHg without other reasonable causes, partial pressure of oxygen in artery \< 80 mmHg * Confirmed diagnosis: intraoperative TEE (direct demonstration of PE or indirect signs of PE), CT angiography, perfusion lung scan |
| Length of stay | 7 days after surgery | * Hospital stay * ICU stay |
| Number of patients with postoperative organ dysfunction | 7 days after surgery | Organ dysfunction * acute kidney injury * acute respiratory distress syndrome |
| Rate of TEE utilization | 7 days after surgery | TEE utilization * for monitoring (use when the case begins) * for rescue (use when unexplained hypotension or hemodynamic collapsed) |
| Mortality rate at 30 days postoperative | 30 days after surgery | Patients death after surgery |
Countries
Thailand
Outcome results
None listed