Background Nephrectomy, either partial or radical, is a key treatment for kidney cancer. The surgical approach—open, laparoscopic, or robot-assisted—can influence perioperative outcomes. This study evaluates acute kidney injury (AKI) and perioperative complications across these modalities.

Methods We conducted a retrospective analysis using the National Inpatient Sample (NIS) of 2020–2021 to examine 12,676 kidney cancer patients who underwent nephrectomy. Patients were stratified by surgical approach: open, laparoscopic, and robot-assisted. Primary outcomes included AKI incidence, length of stay, and intra- and post-operative complications. Multivariable regression models adjusted for confounding variables, including age, sex, race, Charlson Comorbidity Index (CCI), hospital region, and teaching status.

Results Patients undergoing open nephrectomy had the highest AKI rates, particularly for radical nephrectomy (22.13% vs. 16.52% for robotic, p < 0.001). Similarly, patients treated with open surgery had longer hospital stays and higher rates of complications, including pulmonary (7.71% vs. 4.17%, p < 0.001) and vascular (12.11% vs. 4.01%, p < 0.001) in radical nephrectomy. Multivariate analysis confirmed the increased risk of AKI and complications in open nephrectomy, with robotic-assisted surgery demonstrating the best perioperative outcomes.

Conclusion Open nephrectomy, whether partial or radical, is associated with higher AKI rates and perioperative complications compared to laparoscopic and robot-assisted surgeries. Robot-assisted nephrectomy, with its lower complication rates and shorter hospital stays, may be the preferred approach when feasible. Further efforts to expand access to minimally invasive techniques could improve outcomes for kidney cancer patients.

The authors have declared no competing interest.

This study did not receive any funding.

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The study used ONLY openly available human data National In-patient Sample(NIS) that were originally located at https://hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp

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