Hospitalization After Renal Ablation Unnecessary
TAMPA, Fla.—Ablation of renal masses can be performed routinely as outpatient procedures and usually do not require hospital admission for post-procedure observation, researchers reported here at the Society of Interventional Radiology annual meeting.
In a study, they found that all immediate complications requiring intervention were discovered during the procedure or during the post-procedural four-hour monitoring period. Moreover, any delayed complications requiring intervention would not have been discovered even if patients were routinely admitted after renal ablation.
Institutions vary in their standard of care, with some routinely admitting all patients following renal mass ablation and others performing the procedures solely on an outpatient basis.
Although inpatient admission allows for continued close post-procedure monitoring and could lead to earlier detection and treatment of complications, inpatient care may be detrimental because it increases the risks of hospital-related complications such as acquired infections. Hospitalization also significantly increases costs and can cause an emotional stress on a patient.
At Long Island Jewish Medical Center in New York, interventionalists routinely have performed renal ablations as an outpatient procedure for the past five years. They examined the risks and benefits of outpatient versus inpatient admission for renal ablation in a study of 150 patients treated since 2004. Patients underwent 165 treatments with radiofrequency ablation and/or cryoablation.
Of the 150 patients, 24% had prior partial or total nephrectomies and 59% had a history of cancer. The most common comorbidities were hypertension (67%), hypercholesterolemia (35%), diabetes (20%), coronary artery disease (18%), hypothyroidism (17%), and peripheral vascular disease (12%). Patients had a mean age of 69 years (range 45-90 years). The lesions had an average diameter of 2.4 cm (range 1-6 cm.
Complications occurred in 22 (13%) patients. In 16 patients, the complications were discovered the day of the procedure. These complications included eight hemorrhages (ranging from perinephric hematoma to intraperitoneal extension), six pneumothoraces, one episode of rapid atrial fibrillation, and one hypotensive episode. Six complications were discovered three days to two months after the procedure.
“In the very beginning, during the very first few cases, we admitted the patients for observation. Then we realized we were wasting our time and the patients' time,” said study investigator Igor Lobko, MD, Assistant Professor of Radiology at Albert Einstein College of Medicine and an assistant chief of vascular/interventional radiology at Long Island Jewish. “It is basically a waste of money, too.”
Of the 16 patients with complications discovered the day of the procedure, eight (4.8%) of all patients treated) required hospitalization. The complications requiring admission included five hemorrhages, two pneumothoraces, and one hypotensive episode thought to be secondary to anesthesia.
“This is the first study to really include this many patients and examine this issue,” Dr. Lobko told Renal & Urology News. “So our findings are important and they justify doing these ablations as outpatient procedures.”