Incidence, risk factors and prognosis of changes in serum creatinine early after aortic abdominal surgery.
OBJECTIVE
To determine the incidence, risk factors, and prognostic implications of serum creatinine changes following major vascular surgery.


METHODS
Observational study.


METHODS
University hospital.


METHODS
Cohort of 599 consecutive patients undergoing elective abdominal aortic surgery.


METHODS
Review of prospectively collected data from 1993 to 2004.


RESULTS
The receiver-operator characteristic (ROC) curve analysis was used to detect the best threshold for postoperative elevation in serum creatinine (Delta Creat) in relation to major complications. A cut-off value of +0.5 mg/dl was selected to define renal dysfunction (RD(0.5) group, n=91; no RD(0.5), n=508) that was associated with higher mortality (7.7% in RD(0.5) group vs 1.4% in no RD(0.5) group, P<0.05), rate of admission to the ICU (34% vs 13%, P<0.05), and incidence of cardiovascular (9% vs 4%, P<0.05), respiratory (21% vs 7%, P<0.05), surgical (24% vs 10%, P<0.05), and septic complications (9% vs 3%, P<0.05). After multivariate analysis with logistic regression, renal dysfunction was independently related to low preoperative creatinine clearance [<40 ml/min; odds ratio (OR) 1.5, 95% confidence interval (CI) 1.1-3.9], prolonged renal ischemic time (>40 min; OR, 3.8, 95% CI, 1.9-7.2), blood transfusion (>5 units; OR, 1.9, 95% CI 1.2-6.1), and rhabdomyolysis (OR, 3.6, 95% CI 1.7-7.9).


CONCLUSIONS
Postoperative RD(0.5) (Delta Creat >0.5 mg/dl) occurs in 15% of vascular patients and carries a bad prognosis. Preoperative renal insufficiency and factors related to the complexity of surgery are the main predictors of renal dysfunction.
Ellenberger
Christoph
C
Anesthetics and Critical Care, University Hospital, rue Micheli-Ducrest, 1211, Genève 14, Switzerland.
Schweizer
Alexandre
A
Diaper
John
J
Kalangos
Afksendiyos
A
Murith
Nicolas
N
Katchatourian
Gregory
G
Panos
Aristote
A
Licker
Marc
M
D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology
D015415:Biomarkers; D003404:Creatinine