Does chronic kidney disease affect outcomes after major abdominal surgery? Results from the National Surgical Quality Improvement Program.
BACKGROUND
The impact of chronic kidney disease (CKD) and end-stage renal disease on outcomes following major abdominal surgery is not well defined.


METHODS
The 2008 NSQIP database was queried to identify adult patients undergoing complex abdominal surgery (major colorectal, hepatobiliary, pancreatic, gastric, and esophageal operations). Thirty-day morbidity and mortality in patients on hemodialysis (HD) versus patients not on HD were compared. The impact of preoperative renal insufficiency, measured by glomerular filtration rate (GFR), on morbidity and mortality was then assessed in non-dialysis patients.


RESULTS
Of 24,572 patients who underwent major abdominal operations, excluding emergency cases, only 149 (0.6%) were on HD preoperatively. Thirty-day mortality in the HD group was 12.8% compared to 1.8% for those not on HD (p < 0.0001). Overall complication rate was 23.5 versus 12.3% (p < 0.0001). In particular, rates of pneumonia (6.7 vs 3.0%, p < 0.05) and sepsis (12.8 vs 5.3%, p < 0.001) were higher in patients on HD. In patients not on HD, GFR was significantly predictive of postoperative mortality after controlling for age, gender, race, emergency status, and comorbidities. Compared to patients with normal preoperative kidney function (GFR, 75-90 ml/min/1.73 m(2)), even modest CKD (GFR, 45-60 ml/min/1.73 m(2)) was associated with increased postoperative mortality (odds ratio (OR), 1.62). With greater impairment in kidney function, postoperative mortality was even more marked (GFR, 30-45 ml/min/1.73 m(2) and OR, 2.84; GFR, 15-30 ml/min/1.73 m(2) and OR, 5.56). In addition, CKD was independently associated with increased postoperative complications.


CONCLUSIONS
Any degree of preoperative kidney impairment, even mild asymptomatic disease, is associated with clinically significant increases in 30-day postoperative morbidity and mortality following major abdominal surgery.
Department of Surgery, Stanford University, 300 Pasteur Dr, MC5641, Stanford, CA, 94305, USA, jcloyd@stanford.edu.
Jordan M
JM
Cloyd
Yifei
Y
Ma
John M
JM
Morton
Manjula
M
Kurella Tamura
George A
GA
Poultsides
Brendan C
BC
Visser
D000368:Aged; D016022:Case-Control Studies; D004066:Digestive System Diseases / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D018805:Sepsis / Q000453:epidemiology; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology