Perioperative Outcomes After Radical Nephrectomy with Inferior Vena Cava Thrombectomy

Background and Objective: We aimed to evaluate current trends and complications after radical nephrectomy with inferior vena cava (IVC) thrombectomy and to provide evidence on the role of the annual hospital caseload on perioperative outcomes. Methods: We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the German Bureau of Statistics (2005-2022). All hospitals performing radical nephrectomy with IVC thrombectomy were subclassified based on their annual caseload to low- (<3 cases/year), intermediate- (3-9 cases/year), and high-volume centers (>= 10 cases/year). We included 3608 patients. Key Findings and Limitations: Overall, 1880 (52%) patients underwent surgery in low-, 1466 (40%) in intermediate-, and 848 (8%) in high-volume centers. Most patients (3574, 99%) underwent open surgery. The number of patients undergoing radical nephrectomy with IVC thrombectomy has decreased in the last years. Patients undergoing surgery in low-, intermediate- and high-volume centers had similar baseline characteristics. Operation in high-volume centers, compared to low-volume centers, was associated with lower odds of intensive care unit admission (29% versus 45%, OR: 0.5, 95% CI: 0.4-0.7, p < 0.001) and a shorter hospital stay by 3.9 days (95% CI: 2.2-5.6, p < 0.001). Importantly, for every additional case performed annually, hospitals improve their perioperative outcomes in terms of mortality (p = 0.032), intensive care unit admissions (p = 0.002), acute kidney disease (p = 0.029), and length of hospital stay (p < 0.001). Conclusions and Clinical Implications: The present real-world data demonstrate that, for every additional case performed annually, hospitals improve their perioperative outcomes in terms of major perioperative complications.