About the Audit
This audit includes nephrectomies, nephroureterectomies & partial nephrectomies carried out either through a conventional open incision or through several keyhole incisions (laparoscopic or robotic assisted laparoscopic).
- nephrectomy involves removal of the kidney for benign or malignant disease,
- nephroureterectomy involves removal of the kidney (and surrounding fat) for suspected cancer of the kidney and/or ureter, together with the whole ureter (the tube that carries urine from the kidney to the bladder) and
- partial nephrectomy involves removal of part of the kidney with the surrounding fat for suspected cancer of the kidney or for some benign causes.
The nephrectomy database was originally set up in 2001 to monitor and assist the introduction of laparoscopic nephrectomy (keyhole surgery). In 2012, when BAUS first published individual outcomes data, this procedure was chosen because it was undertaken by approximately one third (35%) of all urologists. The database has been amended in subsequent years to include all three procedures outlined above, performed both open and laparoscopically (keyhole).
Cumulative data from previous years are available on the Data & Audit pages of the Professionals section.
Interpretation of the data
In 2016, we are publishing our fourth year of nephrectomy data; for those surgeons who had started their nephrectomy practice before 2013 and are still in practice, three years' of data (2013, 2014 & 2015) are displayed.
As in previous years, we are publishing information on complication and transfusion rates which has been risk-adjusted. However we recognise that our risk adjustment models are, relatively speaking, in their infancy. This is an area we will continue to work on, because there are many factors that may impact upon the results of surgery, including:
- size and complexity of the tumour
- presence of stones or infection in non-malignant cases
- other medical conditions affecting the patient
- other risk factors for surgery in general
The mortality rate is NOT risk-adjusted because mortality is, fortunately, a relatively rare event in relation to this procedure and risk-adjustment of such small numbers is not accurate enough.
Variations in the data between individual surgeons and units may be a reflection of case complexity or patient factors. As a result, BAUS recommends that:
“... individual patients must discuss the likely outcomes of nephrectomy with their urologist before an operation so they can understand the expected outcome, taking account of the complexity of the technical problem in the context of their general health and their particular case."
The data presented are surgeon-reported by entry into the BAUS Data & Audit System. There is, therefore, no reliable method for validating the data other than by comparing with Hospital Episode Statistics (HES) .
There are no financial incentives (or sanctions) for hospitals and Trusts to support collection of nephrectomy data, and this may also account for the data being incomplete.