Perioperative Complications and In-Hospital Mortality in Radical Nephroureterectomy Patients with Heart Valve Replacement

Background: Perioperative complication rates and in-hospital mortality after radical nephroureterectomy (RNU) in patients with a history of heart valve replacement are unknown. Methods: Within the National Inpatient Sample (2000-2019), we identified non-metastatic upper urinary tract carcinoma patients treated with RNU according to the presence or absence of a history of heart valve replacement. Propensity score matching (1:10 ratio) and multivariable logistic regression as well as Poisson regression models were used. Results: Of 15,423 RNU patients, 151 (1.0%) harbored heart valve replacement. This proportion increased over the study span from 0.5% to 1.4% (p = 0.02). Heart valve replacement patients were older (median 78 vs. 72 years; p < 0.001), more frequently male (73 vs. 60%; p = 0.002), and more frequently harbored a Charlson Comorbidity Index (CCI) ≥3 (36 vs. 27%; p = 0.002). After 1:10 propensity score matching for age, sex, and CCI, the patients exhibited higher rates of perioperative bleeding (7.4 vs. 2.4%; odds ratio [OR] 3.2; p < 0.001), blood transfusions (24.0 vs. 17.0%; OR 1.6; p = 0.02), and cardiac complications (24.0 vs. 14.0%; OR 2.1; p < 0.001). Conversely, heart valve replacement patients did not exhibit higher rates of critical care therapy (OR 1.06; p = 0.8), higher rates of in-hospital mortality (OR 0.8; p = 0.8), and longer length of stay (OR 1.4; p = 0.052) than their RNU counterparts without a history of heart valve replacement. Conclusion: RNU patients with a history of heart valve replacement are at significantly increased risk of perioperative bleeding, blood transfusions, and cardiac complications; however, despite these increased risks, they neither exhibited higher critical care therapy rates or higher in-hospital mortality rates, nor did they require significantly longer hospital stay.