Are postoperative complications more common following colon and rectal surgery in patients with chronic kidney disease?
OBJECTIVE
According to National Kidney Foundation guidelines, early stages of chronic kidney disease (CKD) can be detected through the estimated glomerular filtration rate (eGFR). We assessed complications following colorectal surgery (CRS) in patients with CKD Stages 3 and 4, as defined by the eGFR.


METHODS
Patients with CKD were identified within our database. Patients with an eGFR of 15-59 ml/min (CKD Stages 3 and 4) formed the CKD group and were compared with American Society of Anesthesiology (ASA) score-matched controls with an eGFR of ≥ 60 ml/min. Assessments included demographics, comorbidity, ASA score, operative details and 30-day postoperative outcome.


RESULTS
Seventy patients in the CKD group were matched with 70 controls. ASA scores and length of stay did not differ significantly between the groups. CKD patients were older (mean age 76.5 years vs 71.1 years; P < 0.001) and had a lower mean body mass index (24.3 vs 28.2; P < 0.001) compared with controls. Compared with the CKD group, the mean operation time was longer in the control group (181.5 min vs 151.6 min; P = 0.02) and the estimated blood loss was greater (232 ml vs 165 ml; P = 0.004). Postoperative infection was more common in the CKD group (60%vs 40%; P = 0.01). There were no significant differences in reoperation rates, 30-day readmissions or the incidence of acute renal failure (ARF).


CONCLUSIONS
Patients with CKD Stages 3 and 4 had a higher incidence of postoperative infections than matched controls after colorectal surgery. ARF developed in 18.6% of patients. Preoperative optimization should include adequate hydration and assessment of potentially nephrotoxic substances for bowel preparation, preoperative antibiotics and pain control.
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
J
J
Canedo
K
K
Ricciardi
G
G
DaSilva
L
L
Rosen
E G
EG
Weiss
S D
SD
Wexner
D000368:Aged; D000704:Analysis of Variance; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D003108:Colonic Diseases / Q000150:complications / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007239:Infections / Q000209:etiology*; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D012002:Rectal Diseases / Q000150:complications / Q000601:surgery*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D018709:Statistics, Nonparametric