© 2009 THE AUTHORS 102 JOURNAL COMPILATION © 2 0 0 9 B J U I N T E R N A T I O N A L | 1 0 6 , 1 0 2 – 1 0 6 | doi:10.1111/j.1464-410X.2009.09015.x 2009 THE AUTHORS. JOURNAL COMPILATION 2009 BJU INTERNATIONAL Upper Urinary Tract OPEN RENAL BIOPSY STEC et al. Open renal biopsy: comorbidities and complications in a contemporary series Andrew A. Stec, Kelly L. Stratton, Melissa R. Kaufman, Sam S. Chang, Douglas F. Milam, S. Duke Herrell, Roger R. Dmochowski, Joseph A. Smith Jr, Peter E. Clark and Michael S. Cookson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA Accepted for publication 13 August 2009 RESULTS In all, 115 patients had ORB between 1991 and 2006 (mean age 48 years, range 18–83); 60% of the patients were American Society of Anesthesiologists class ≥3. The median Charlson comorbidity index score was 3, with a score of 0 in 20.9%, 1–2 in 27.8%, 3–4 in 30.4% and ≥5 in 20.9% of patients. Indications for an ORB included morbid obesity, failed PRB, coagulopathy, and solitary kidney. In all, 47.8% of patients had a serum creatinine level of <3.0 mg/dL, 34.8% of >3.0 mg/dL and 17.4% were dialysis-dependent. There were 43 complications in 36 patients. The mortality rate after surgery was 0.8%. There were eight major complications in seven patients (6.1%) including cardiac arrest, stroke, sepsis, reoperation and re-intubation. There were minor complications 34 times in 31 patients (27%), the most common being wound infection, pneumonia, intraoperative transfusion of >2 units, arrhythmia, postoperative retroperitoneal bleed, and seep vein thrombosis. CONCLUSIONS This study shows that there are significant comorbidities in patients referred to urologists for an ORB. With a mortality rate of 0.8% and major and minor complication rates of 6.1% and 27%, respectively, the ORB, while infrequent, carries a significant risk in this population that should be included in preoperative decision making and used for patient counselling. KEYWORDS renal biopsy, open biopsy, complications, outcomes, kidney Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To report the indications and outcomes of a contemporary series of patients with contraindications to percutaneous renal biopsies (PRBs) who had an operative RB (ORB), as although ORB is a relatively infrequent procedure, it remains an important and underreported operation. PATIENTS AND METHODS In a retrospective review of patients who had an ORB we examined comorbidities, indications, and 30-day morbidity and mortality. Preoperative comorbidities were stratified according to the Charlson comorbidity index. INTRODUCTION The diagnosis and treatment of renal insufficiency (RI), both acute and chronic, has become dependent upon the histological diagnosis of medical renal diseases. This pathological diagnosis is primarily obtained by percutaneous renal biopsy (PRB), generally a safe and successful procedure. The tailoring of the PRB technique has largely made the operative renal biopsy (ORB) obsolete, but this procedure is still used in selected centres on patients with relative contraindications to a PRB. In 1923, Gwyn [1] initially described the technique of ORB; 11 years later, Ball [2] described the first percutaneous biopsy of the kidney. For the past eight decades these two techniques have been honed and the more minimally invasive percutaneous procedure has gained favour for routine RB. Historically, the ORB has been a safe procedure with a relatively low complication rate. The largest series of patients from Japan reported no major complications, no blood product transfusions and very few minor complications [3]. Similar reports of low complication rates were also confirmed by Finan et al. [4] in a series of 50 consecutive patients, and by Gonick et al. [5] in 202 patients [4,5]. Also, all of these series reported excellent results for obtaining adequate tissue samples for pathological diagnosis. Importantly, none of these large series contain details about the medical conditions and comorbidities of their patients. Only one series [6] reported the complication rates when ORBs were taken in a more critically ill group of patients, predominantly those who were uraemic at the time of biopsy. Patil et al. [6] reported significant complications, with up to 15% having a pulmonary complication, 15% receiving transfusions, 6% wound infections and 37% developing fevers of >37.8°C. Since the 1980s no further data have been published on the safety and outcomes of ORB, presumably due to the increasing acceptance of the PRB as the standard technique. Several studies reported that PRB is as safe, if not safer BJUI BJU INTERNATIONAL