Predictors of health‐related quality of life recovery following laparoscopic simple, radical and donor nephrectomy

• Published in: BJU international 2011-02, Vol.107 (4), p.636-641
• Main Authors: Wiesenthal, Joshua D., Schuler, Trevor D., Honey, R. John D’A., Pace, Kenneth T.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Epidemiologic Methods; Female; Humans; Kidney Diseases - rehabilitation; Kidney Diseases - surgery; Kidney Transplantation; Laparoscopy; Living Donors; Male; Medical sciences; Middle Aged; nephrectomy; Nephrectomy - methods; Nephrectomy - rehabilitation; Nephrology. Urinary tract diseases; outcomes; Quality of Life; recovery; Treatment Outcome
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2010.09571.x

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Despite laparoscopy becoming the favoured approach for nephrectomy, there is very little research into the predictors of recovery following surgery and return of health‐related quality of life following laparoscopic nephrectomy. The current study demonstrates that patients who are younger, have lower BMI, have more active lifestyles and those who are not donating a kidney recover more quickly following surgery. Older, more obese, less active patients, and those donating a kidney take longer to recover from surgery. OBJECTIVES To objectively quantify the recovery of health‐related quality of life (HRQL) in patients undergoing laparoscopic nephrectomy. To determine which factors are predictive of a more expedited recovery. MATERIALS AND METHODS Patient recovery was prospectively measured among patients undergoing laparoscopic simple (n= 12), radical (n= 42) and donor (n= 95) nephrectomy. All procedures were performed using a 3‐ or 4‐trocar, transperitoneal fully‐laparoscopic technique with intact specimen extraction using impermeable sacs for simple and radical nephrectomy, and hand extraction for donor nephrectomy. Postoperative recovery and quality of life were measured using the Postoperative Recovery Scale (PRS) administered preoperatively, immediately postoperatively and as an outpatient at 4, 8, 12, and 16 weeks postoperatively. ANOVA and Pearson’s χ2 tests were performed on demographic data. Multivariate logistic regression analysis was used to calculate odds ratios for factors predictive of recovery. RESULTS Statistically significant differences were found at baseline for age (P= 0.02), gender (P < 0.01), body mass index (BMI; P= 0.03), surgical side (P < 0.01) and activity‐based lifestyle (P= 0.04) across the three groups. Minimal adverse events were seen. Factors predictive of expedited recovery include age < 50 years (OR: 2.1, P < 0.01), body‐mass index (BMI) < 30 kg/m2 (OR: 1.7, P < 0.01), active lifestyles (OR: 1.3, P < 0.01) and those patients undergoing nephrectomy for benign or malignant indications rather than for organ donation (OR: 1.4, P < 0.01). There was a significant delay in the donor group vs the non‐donor group with respect to the median number of days both groups took to recover 75% and 90% of their baseline PRS scores (11 days, P= 0.02; 20 days, P= 0.02, respectively). CONCLUSIONS Predictive factors of recovery from lap