The Incidence of Pulmonary Embolism During Nephrectomy

Study Overview
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Brief Summary
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Patients with renal carcinoma was reported at high incidence of perioperative pulmonary embolism from current study. The investigators aimed to determine the incidence and outcome of this group of patient in the tertiary-care, university hospital and the rate of intraoperative transesophageal echocardiography utility and outcome.

Detailed Description
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Perioperative pulmonary embolism (PE) is the serious adverse event leading to major morbidity and mortality. The incidence of PE during urologic surgery was previously report at 0.9 - 1.1% with mortality rate less than 2%. But the recent study by Fukazawa et al report the incidence of PE was 11% in renal cancer patients underwent nephrectomy with mortality rate as high as 33%. The risk factors associated with PE included major surgery, cancer, arrhythmia, massive bleeding and level of tumor thrombus in inferior vena cava. Transesophageal echocardiography (TEE) is a very helpful intraoperative monitoring tool in major, non-cardiac surgery to detect emboli and guide the hemodynamic management in severely unstable patients. But it requires sophisticate machine and well-trained operator, the rate of utilisation was still limited. The investigators aimed to determine the incidence of perioperative PE in renal cancer patients undergoing nephrectomy. the secondary outcomes include risk factors associated with perioperative PE, clinical outcomes, the rate of TEE utilization in this operation and outcome.

Official Title
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The Incidence of Perioperative Pulmonary Embolism in Patients With Renal Carcinoma Undergoing Nephrectomy

Conditions
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Pulmonary Embolism, Renal Cell Carcinoma, Nephrectomy

Intervention / Treatment
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* Other: Nephrectomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients with renal cancer undergoing nephrectomy Exclusion Criteria: Patients with incomplete data

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Nephrectomy<br>Patients underwent nephrectomy | Other: Nephrectomy<br>* Patients underwent nephrectomy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of intraoperative PE of renal cancer patient undergoing nephrectomy | Pulmonary embolism Clinical suspicious:Systolic blood pressure < 90 mmHg without other reasonable causes, partial pressure of oxygen in artery < 80 mmHg Confirmed diagnosis: intraoperative TEE (direct demonstration of PE or indirect signs of PE), CT angiography, perfusion lung scan | intraoperative period | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of postoperative PE of renal cancer patient undergoing nephrectomy | Pulmonary embolism Clinical suspicious:Systolic blood pressure < 90 mmHg without other reasonable causes, partial pressure of oxygen in artery < 80 mmHg Confirmed diagnosis: intraoperative TEE (direct demonstration of PE or indirect signs of PE), CT angiography, perfusion lung scan | until 7 days after surgery | 
| Length of stay | Hospital stay ICU stay | 7 days after surgery | 
| Number of patients with postoperative organ dysfunction | Organ dysfunction acute kidney injury acute respiratory distress syndrome | 7 days after surgery | 
| Rate of TEE utilization | TEE utilization for monitoring (use when the case begins) for rescue (use when unexplained hypotension or hemodynamic collapsed) | 7 days after surgery | 
| Mortality rate at 30 days postoperative | Patients death after surgery | 30 days after surgery |