Comorbidity and Risk of Complications and Readmissions Following Surgery for Patients With Renal Cell Carcinoma in the Military Health System

Objectives: – The effect of comorbidity on kidney and urinary complications after surgery for renal cell carcinoma (RCC) is unclear. We aimed to assess the effect of comorbidity on postoperative complications and readmissions among patients with RCC in the Military Health System, which provides universal access to care to eligible beneficiaries. Methods: – We identified a cohort of patients aged 18 and older diagnosed with stage I to III RCC between 2001 and 2014 who received nephrectomy in the MilCanEpi database. Outcomes included 90-day general and kidney and urinary complications and hospital readmissions. The adjusted rate ratios (ARRs) with 95% CIs for Elixhauser comorbidity (0, 1 to 2, 3 to 4, ≥5) and outcomes were estimated using multivariable Poisson regression. Results: – The study included 1470 patients with a median (IQR) comorbidity count of 2 (0 to 3). Overall, patients with ≥5 comorbidities had elevated rates of general complications (ARR=1.47, 95% CI=0.96, 2.23) relative to patients with no comorbidity. For kidney and urinary complications, patients with 1 to 2 (ARR=1.65, 95% CI=1.07, 2.54), 3 to 4 (ARR=2.29, 95% CI=1.45, 3.62), and ≥5 comorbidities (ARR=2.64, 95% CI=1.60, 4.34) had statistically significant higher risks relative to patients with no comorbidity. Patients with ≥5 comorbidities had higher risk of readmission (ARR=1.65, 95% CI=1.08, 2.54 vs. no comorbidity), while the risks were not statistically different for patients with lower comorbidity. Conclusions: – The results demonstrate the increased risk for postoperative kidney and urinary complications and readmissions for patients with RCC and comorbidity and highlights the importance of comorbidity management in surgical care among patients with RCC.