title: The impact of pre-operative serum creatinine on short-term outcomes after liver resection.
abstract: BACKGROUND
  The aim of the present study was to determine whether raised pre-operative serum creatinine increased the risk of renal failure after liver resection.
  
  
  METHODS
  Data were studied from 1535 consecutive liver resections. Outcomes in patients with pre-operative creatinine </=124 micromol/l (Group 1) were compared with those with pre-operative creatinine >/=125 micromol/l (Group 2).
  
  
  RESULTS
  The median age of the 1446 (94.3%) patients resected in Group 1 was 62 years compared with 67 years in the 88 (5.7%) patients in Group 2 (P < 0.0001). Similarly this latter group had double the number of patients who were American Society of Anesthesiologists (ASA) III or IV (34.1% vs. 15.2%, P= 0.00004). Overall, the incidence of post-operative renal failure requiring haemofiltration was low (0.9%) but significantly more in Group 2 patients (5.7% vs. 0.6, P= 0.0007). In addition, patients in Group 2 were more likely to suffer acute kidney injury post-operatively (18.2% vs. 4.3%, P < 0.0001). Patients with acute kidney injury had significantly higher blood loss. Although there was no difference in mortality, patients in Group 2 had higher post-operative morbidity (37.5%) than Group 1 (21.7%, P= 0.0006), with the incidence of cardiorespiratory complications being higher in Group 2 (25.9% vs. 8.9%, P= 0.0025).
  
  
  CONCLUSIONS
  After liver resection, renal failure is rare but patients with an elevated creatinine pre-operatively are at an increased risk of both renal and non-renal complications.
authors.affiliation: Department of Hepatobiliary Surgery, Basingstoke and North Hampshire Foundation Trust Basingstoke, Hampshire, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Armstrong
authors.forename: Fenella Ks
authors.initials: FK
authors.lastname: Welsh
authors.forename: John
authors.initials: J
authors.lastname: Wells
authors.forename: Kandiah
authors.initials: K
authors.lastname: Chandrakumaran
authors.forename: Timothy G
authors.initials: TG
authors.lastname: John
authors.forename: Myrddin
authors.initials: M
authors.lastname: Rees