Login to Access Video or Poster Abstract: MP22-20
Sources of Funding: None

Introduction

Paraneoplastic syndromes are present in about 20% of renal cell carcinoma (RCC) cases and are associated with poor oncologic outcomes. These data, however, are based on single institution studies and it is unknown if abnormal preoperative lab values are associated with postoperative complication rates. We sought to characterize abnormal lab values suggestive of paraneoplastic syndromes in patients undergoing surgery for RCC and evaluate their association with postoperative complications.

Methods

Using the National Surgical Quality Improvement Program (NSQIP) database, we identified all patients having surgery for RCC from 2005-2014. We queried Participant User Files with ICD-9 codes for RCC (189.00) and CPT codes for partial or radical nephrectomy (50220, 50225, 50230, 50240, 50543, 50545, 50546) selecting localized disease. We identified abnormal preoperative lab values consistent with paraneoplastic syndromes and categorized renal function by chronic kidney disease (CKD) stage. Normal lab reference ranges were defined using data from the National Library of Medicine where ranges delimit 2 standard deviations (SD) of the mean value. We used logistic regression to test if abnormal preoperative lab values were associated with postoperative complications, including postoperative transfusion, readmission and death. We extended the normal range of lab values to 3SD of the mean for a sensitivity analysis.

Results

A total of 12,986 patients were identified. At least 1 lab abnormality suggestive of a paraneoplastic syndrome was identified in 46% of patients (Table 1) and CKD stage >3 was found in 27% of patients. On multivariate analysis, the presence of a preoperative lab abnormality was associated with an increased odds of postoperative transfusion (OR [95% CI]: 2.84 [2.47-3.25], p<0.01), readmission (1.31 [1.09-1.58], p<0.01) and death (2.42 [1.25-4.70], p<0.01) controlling for patient and surgical factors. When we extended the range of normal to 3SD, 29% had abnormal labs and our conclusions were unchanged.

Conclusions

About one half of patients presenting for surgery for RCC have abnormal lab values suggestive of paraneoplastic syndromes. These patients may be at increased risk of postoperative events including bleeding, readmission, and death.

Funding

None