Document Detail


Does Mechanical Bowel Preparation Improve Quality of Laparoscopic Nephrectomy? Propensity Score-matched Analysis in Japanese Series.
MedLine Citation:
PMID:  23273073     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: To assess the effect of mechanical bowel preparation (MBP) before laparoscopic nephrectomy in terms of operation time and perioperative complications.
MATERIALS AND METHODS: Patients undergoing laparoscopic nephrectomy for T1-T3 tumors were identified in the Japanese Diagnosis Procedure Combination database from 2008 to 2010. The patients were stratified into a preoperative MBP group (polyethylene glycol electrolyte, magnesium citrate solution, and sodium picosulfate) and a non-MBP group and were matched using one-to-one propensity score matching according to age, sex, Charlson score, T category, hospital volume, and hospital academic status. The operation time, postoperative length of stay, and overall complication rate were assessed by multivariate regression analyses.
RESULTS: Of 2740 patients in 355 hospitals, 1110 pairs were generated. The median operation time, postoperative stay, and overall complication rate (MBP vs non-MBP group) was 278 and 268 minutes (P <.004), 10.3 and 10.0 days (P = .695), and 11.8% and 11.4% (P = .740), respectively. The multivariate regression analyses did not find significant superiority of MBP for the 3 endpoints (all P >.05). A shorter operation time was significantly associated with female sex and early-stage tumor. Older age, greater Charlson score, and lower hospital volume adversely affected the postoperative stay and overall complication rate. Stage T3 tumor was unfavorable for the postoperative stay.
CONCLUSION: Our large-scale propensity score-matched analysis did not demonstrate a benefit for MBP in operation time, postoperative stay, or overall complications. The results suggest that MBP can be safely omitted before laparoscopic nephrectomy for T1-T3 tumors.
Authors:
Toru Sugihara; Hideo Yasunaga; Hiromasa Horiguchi; Tetsuya Fujimura; Hiroaki Nishimatsu; Kazuhiko Ohe; Shinya Matsuda; Kiyohide Fushimi; Michael W Kattan; Yukio Homma
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Urology     Volume:  81     ISSN:  1527-9995     ISO Abbreviation:  Urology     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0366151     Medline TA:  Urology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  74-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Affiliation:
Department of Urology, Shintoshi Hospital, Iwata, Japan; Department of Urology, University of Tokyo, Tokyo, Japan. Electronic address: ezy04707@nifty.com.
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