Complications after radical nephrectomy according to age: analysis from the British Association of Urological Surgeons Nephrectomy Audit

Introduction To compare complication rates in radical nephrectomy for renal cell carcinoma across different age groups. Methods Retrospective analysis of the British Association of Urological Surgeons Nephrectomy Audit database between 1st January 2012 and 31st December 2017 was performed. Comparisons were made between different age groups (<60, 60-79, ≥80) in patients undergoing radical nephrectomy for renal cell carcinoma. Results 18438 patients with renal cell carcinoma underwent radical nephrectomy: 6128 (33.2%) aged <60, 10785 (58.5%) aged 60-79 and 1525 (8.3%) aged ≥80. There was a significantly lower pre-operative haemoglobin and eGFR with advancing age (p<0.001). Patients ≥80 had a higher Charlson co-morbidity index and WHO performance status (p<0.001). There was also significant variability in the approach to RN (p<0.001): laparoscopy was most commonly performed (68.8% vs. 69.3% vs. 75.0%). Patients ≥80 years were found to have the shortest operating time (p<0.001). There were significant differences in T stage between groups with patients aged ≥80 having a higher T stage (p<0.001). The incidence of intra-operative complications did not significantly differ between age groups (p=0.18). The incidence of post-operative complications was 15.7%, 18.2% and 20.5% and major post-operative complications was 1.4%, 2.1% and 2.8% in patients <60, 60-79 and ≥80, respectively (p<0.001). The most common complication in all age groups was blood transfusion (7.6% <60, 8.6% 60-79, 9.1% ≥80). Stepwise logistic regression analysis adjusting for additional variables found the odds of a post-operative complication increased with age with an odds ratio of 1.25 in patients ≥80 and an odds ratio of 1.09 in patients aged 60-70 compared with <60. Conclusion Overall complications in all age groups are low but advancing age should be considered as an independent risk factor for post-operative complications after radical nephrectomy and should be appropriately considered when counselling elderly patients prior to treatment.