title: The impact of renal function on outcomes of bariatric surgery.
abstract: The effect of CKD on the risks of bariatric surgery is not well understood. Using the American College of Surgeons National Surgical Quality Improvement Program Participant Use File, we analyzed 27,736 patients who underwent bariatric surgery from 2006 through 2008. Before surgery, 34 (0.12%) patients were undergoing long-term dialysis. Among those not undergoing dialysis, 20,806 patients (75.0%) had a normal estimated GFR or stage 1 CKD, 5011 (18.07%) had stage 2 CKD, 1734 (6.25%) had stage 3 CKD, 94 (0.34%) had stage 4 CKD, and 91 (0.33%) had stage 5 CKD. In an unadjusted analysis, CKD stage was directly associated with complication rate, ranging from 4.6% for those with stage 1 CKD or normal estimated GFR to 9.9% for those with stage 5 CKD (test for trend, P<0.001). Multivariable logistic regression demonstrated that CKD stage predicts higher complication rates (odds ratio for each higher CKD stage, 1.30) after adjustment for diabetes and hypertension. Although patients with higher CKD stage had higher complication rates, the absolute incidence of complications remained <10%. In conclusion, these data demonstrate higher risks of bariatric surgery among patients with worse renal function, but whether the potential benefits outweigh the risks in this population requires further study.
authors.affiliation: Division of Transplant Surgery, Emory University, Atlanta, Georgia, USA.
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Turgeon
authors.forename: Sebastian
authors.initials: S
authors.lastname: Perez
authors.forename: Max
authors.initials: M
authors.lastname: Mondestin
authors.forename: S Scott
authors.initials: SS
authors.lastname: Davis
authors.forename: Edward
authors.initials: E
authors.lastname: Lin
authors.forename: Sudha
authors.initials: S
authors.lastname: Tata
authors.forename: Allan D
authors.initials: AD
authors.lastname: Kirk
authors.forename: Christian P
authors.initials: CP
authors.lastname: Larsen
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Pearson
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000401:mortality; D015992:Body Mass Index; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology*
chemical_list: D003404:Creatinine