A 3-year review of The British Association of Urological Surgeons Section of Endourology Laparoscopic Nephrectomy Audit

Abstract

Objective: To report and compare the data obtained from the BAUS UK national laparoscopic nephrectomy audit over the past 3 years.

Methods: Each year, consultants performing laparoscopic nephrectomy are invited to submit prospectively collected data on all patients so treated at their centres. The data from each centre is entered into a nationally established database using a standard data-collection sheet. The indications for surgery, and data during and after surgery are collected. Since 2001, data were reported on 1294 laparoscopic nephrectomies.

Results: Over the 3 years, the number of centres returning data has increased from 25 to 48. In 2002, data on 263 nephrectomies were returned; by 2004, this had increased to 598. In all three audits, most cases were for nonfunctioning kidneys and renal cell carcinoma, with transitional cell carcinoma and stones forming a smaller proportion. Over the 3 years, the mean (range) operative duration has reduced from 173 (89-335) to 166 (42-395) min. The median postoperative stay remained at 4-5 days, with a wide range reflecting other than clinical reasons for delayed discharge. The mortality rate remained low, at 0.7% and 0.2%, respectively, for 2002 and 2004. The mean conversion rate remained at 6-8% and the mean complication rate at 17-2%, but the proportion of major complications reduced from 10% to 4%. The transfusion rate also reduced from 10% to 7%. The operative duration, transfusion and conversion rates were higher in those centres performing fewer than 12 cases/year than in those performing at least one case per month.

Conclusion: The BAUS laparoscopic nephrectomy audit is an effective method for ensuring both the safe and widespread implementation of this relatively new technique to the UK, and compliance with internationally accepted standards. This audit has shown differences in clinical outcomes in favour of high-volume centres, which may help to inform decisions about the centralization of urological laparoscopy services.