1075 IMPROVED FUNCTIONAL OUTCOMES WITH SIMILAR CANCER OUTCOMES IN PATIENTS WITH HIGH RISK LOCALIZED RENAL CELL CARCINOMA TREATED WITH PARTIAL AS COMPARED TO RADICAL NEPHRECTOMY

INTRODUCTION AND OBJECTIVES: Associations of the diffusion of laparoscopic partial nephrectomy with patient safety remain uncharacterized. We compared the frequency of adverse patient safety events occurring in laparoscopic versus open partial nephrectomy over a 10-year period. METHODS: We utilized the Nationwide Inpatient Sample (NIS), a 20% sample of inpatient discharges in the U.S., from 1998 to 2008. All raw data was weighted to produce national estimates. We identified discharges with a principal diagnosis of kidney surgery by ICD-9CM codes. The primary outcome was occurrence of any Patient Safety Indicator (PSIs validated measures developed by the Agency for Healthcare Research and Quality to describe adverse outcomes related to patient safety. We used multivariate logistic regression to compare PSIs occurring in laparoscopic and open partial nephrectomy. RESULTS: The prevalence of both open and laparoscopic partial nephrectomy increased steadily during the study period (Figure 1). Compared to open, patients undergoing laparoscopic partial nephrectomy had lower Charlson Index morbidity scores (p 0.001) and were more likely to undergo surgery at urban (p 0.001) and teaching (p 0.001) hospitals. Among the 62,853 open partial nephrectomies and 5,828 laparoscopic partial nephrectomies performed, PSIs occurred in 4,084 (6.5%) and 270 (4.6%) (p 0.019) cases, respectively. On multivariate analysis, there were no significant differences in the probability of at least one PSI between open and laparoscopic partial nephrectomy [Odds Ratio (OR) 0.778, 95% CI 0.579–1.046, p 0.096)]. The probability of any PSI was 38% higher for Charlson 3 compared to 3 (OR 1.38, 95% CI 1.2 to 1.6, p 0.001). CONCLUSIONS: Laparoscopic and open partial nephrectomy demonstrated similar risks of adverse patient safety events as defined by PSIs. These data suggest that, as it has diffused into clinical practice, laparoscopy has remained a relatively safe technique for performing partial nephrectomy.