Temporary worsening of renal function after aortic surgery is associated with higher long-term mortality.
BACKGROUND
Little is known about acute changes in renal function in the postoperative period and the outcome of patients undergoing major vascular surgery. Specifically, data are scarce for patients in whom renal function temporarily decreases and returns to baseline at 3 days after surgery.


METHODS
Retrospective cohort study.


METHODS
1,324 patients who underwent elective open abdominal aortic aneurysm surgery in a single center.


METHODS
Renal function (creatinine clearance was measured preoperatively and on days 1, 2, and 3 after surgery. Patients were divided into 3 groups: group 1, improved or unchanged (change in creatinine clearance, +/-10% of function compared with baseline); group 2, temporary worsening (worsening > 10% at day 1 or 2, then complete recovery within 10% of baseline at day 3); and group 3, persistent worsening (>10% decrease compared with baseline).


METHODS
All-cause mortality.


RESULTS
30-day mortality rates were 1.3%, 5.0%, and 12.6% in groups 1 to 3, respectively. Adjusted for baseline characteristics and postoperative complications, 30-day mortality was the greatest in patients with persistent worsening of renal function (hazard ratio [HR], 7.3; 95% confidence interval [CI], 2.7 to 19.8), followed by those with temporary worsening (HR, 3.7; 95% CI, 1.4 to 9.9). During 6.0 +/- 3.4 years of follow-up, 348 patients (36.5%) died. Risk of late mortality was 1.7 (95% CI, 1.3 to 2.3) in the persistent-worsening group followed by those with temporary worsening (HR, 1.5; 95% CI, 1.2 to 1.4).


CONCLUSIONS
No steady state was achieved to assess renal function.


CONCLUSIONS
Although renal function may recover completely after aortic surgery, temporary worsening of renal function was associated with greater long-term mortality.
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Gijs M J M
GM
Welten
Olaf
O
Schouten
Michel
M
Chonchol
Sanne E
SE
Hoeks
Harm H H
HH
Feringa
Jeroen J
JJ
Bax
Martin
M
Dunkelgrün
Yvette R B M
YR
van Gestel
Ron T
RT
van Domburg
Don
D
Poldermans
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000502:physiology; D007674:Kidney Diseases / Q000401:mortality / Q000503:physiopathology; D007677:Kidney Function Tests / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D013997:Time Factors