Universally Applied Precautionary Measures to Prevent Hypertension in a Partial Nephrectomy Clinical Care Pathway Reduces Incidence of Post Operative Hemorrhage - Abstract
Purpose: Clinical care pathways have been shown to reduce hospital length of stay without increasing post operative adverse events. In the present study, we sought to determine whether universally applied precautionary measures to prevent peri-operative hypertension (HTN) into an established standardized care pathway may reduce acute post operative hemorrhage (APOH) following partial nephrectomy. Methods: We retrospectively reviewed a database comprised of patients undergoing partial nephrectomy at our institution by the same surgical team. Starting in January of 2013, all patients undergoing partial nephrectomy received screening for and universally applied aggressive management of HTN and its prevention in the peri-operative period. The APOH rate was calculated for the study cohort (Group 1, n=52) and compared to the control group (Group 2, n=200) managed immediately preceding implementation of HTN universal precautions. Clinico-pathologic factors assessed for their relationship to APOH were patient age, gender, diabetes, smoking, hypertension, coronary artery disease, American Society of Anesthesia Score (ASA), tumor size, pathologic result, cancer margin status, operative time and estimated intra-operative blood loss. Results: Data were analyzed from 252 consecutive patients. In Group 1 (n=200), 7 patients (3.5%) experienced APOH. In that cohort, risk factors for APOH were male gender and hypertension. The impact of APOH on subsequent hospital course, ancillary procedures and renal loss are reported. In Group 2 (n=52) hypertensive precautions were universally applied. In this cohort, there were no episodes of APOH, and no required ancillary procedures. Conclusion: Our preliminary results at the time of this early interim analysis appear to indicate that hypertensive universal precautions in a previously established partial nephrectomy clinical care pathway reduced the incidence of acute post operative hemorrhage. Reduction of APOH reduced additional adverse post operative sequelae and improved renal preservation.