High early mortality following percutaneous nephrostomy in metastatic cancer: a national analysis of outcomes

Amandeep Dosanjh; Benjamin Coupland; Jemma Mytton; Dominic Stephen King; Harriet Mintz; Anna Lock; Veronica Nanton; Param Mariappan; Nigel Trudgill; Prashant Patel

doi:10.1136/spcare-2024-004937

High early mortality following percutaneous nephrostomy in metastatic cancer: a national analysis of outcomes

BMJ Support Palliat Care. 2024 Jul 13;14(e2):e004937. doi: 10.1136/spcare-2024-004937. Online ahead of print.

Authors

Amandeep Dosanjh¹, Benjamin Coupland², Jemma Mytton², Dominic Stephen King³, Harriet Mintz⁴, Anna Lock⁵, Veronica Nanton⁶, Param Mariappan⁷, Nigel Trudgill^{1

8}, Prashant Patel^{9

10}

Affiliations

¹ University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK.
² Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
³ Department of Gastroenterology, The Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK.
⁴ School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
⁵ Department of Palliative Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
⁶ Department of Social Sciences and Systems in Health, University of Warwick, Coventry, UK.
⁷ Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK.
⁸ Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
⁹ University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK p.patel@bham.ac.uk.
¹⁰ Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.

Abstract

Objectives: To assess the outcomes of percutaneous nephrostomy in England for renal decompression, in the context of metastatic cancer.

Methods: Retrospective observational study of all patients undergoing nephrostomy with a diagnosis of metastatic cancer from 2010 to 2019 in England, identified and followed up within Hospital Episode Statistics.The primary outcome measure was mortality (14-day and 30-day postprocedure). Secondary outcomes included subsequent chemotherapy or surgery and direct complications of nephrostomy.

Results: 10 932 patients were identified: 58.0% were male, 51.0% were >70 years old and 57.7% had no relevant comorbidities (according to Charlson's criteria, other than cancer).1 in 15 patients died within 14 days of nephrostomy and 1 in 6 died within 30 days. Factors associated with higher 30-day mortality were the presence of comorbidities (Charlson score 1-4 (OR 1.27, 95% CI 1.08 to 1.50, p=0.003), score 5+ (OR 1.29, 95% CI 1.14 to 1.45), p<0.001)); inpatient nephrostomy (OR 3.76, 95% CI 2.75 to 5.14, p<0.001) and admitted under the care of specialities of internal medicine (OR 2.10, 95% CI 1.84 to 2.40, p<0.001), oncology (OR 1.80, 95% CI 1.51 to 2.15, p<0.001), gynaecology/gynaeoncology (OR 1.66, 95% CI 1.21 to 2.28, p=0.002) or general surgery (OR 1.62, 95% CI 1.32 to 1.98, p<0.001)), compared with urology.25.4% received subsequent chemotherapy. Receiving chemotherapy was associated with younger patients (eg, age 18-29 (OR 4.04, 95% CI 2.66 to 6.12, p<0.001) and age 30-39 (OR 3.07, 95% CI 2.37 to 3.97, p<0.001)) and under the care of oncology (OR 1.60, 95% CI 1.40 to 1.83, p<0.001) or gynaecology/gynaeoncology (OR 1.64, 95%CI 1.28 to 2.10, p<0.001) compared with urology.43.8% had subsequent abdominopelvic surgery. Not receiving surgery was associated with inpatient nephrostomy (OR 0.82, 95%CI 0.72 to 0.95,p=0.007): non-genitourinary cancers (eg, gynaecology/gynaeoncology cancer (OR 0.86, 95% CI 0.74 to 0.99, p=0.037)); and under the care of a non-surgical specialty (medicine (OR 0.69, 95% CI 0.63 to 0.77, p<0.001), oncology (OR 0.58, 95% CI 0.51 to 0.66, p<0.001)).24.5% of patients had at least one direct complication of nephrostomy: 12.5% required early exchange of nephrostomy, 8.1% had bleeding and 6.7% had pyelonephritis.

Conclusions: The decision to undertake nephrostomy in patients with poor prognosis cancer is complex and should be undertaken in a multidisciplinary team setting. Complication rates are high and minimal survival benefit is derived in many patients, especially in the context of emergency inpatient care.

Keywords: Cancer; Clinical decisions; End of life care; Genitourinary; Palliative Care; Quality of life.