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Does Preoperative Estimated Glomerular Filtration Rate (eGFR) Predict Short-Term Surgical Outcomes in Patients Undergoing Pancreatic Resections?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Preoperative eGFR has been found to be a reliable predictor of post-operative outcomes in patients with normal creatinine levels who undergo surgery. The aim of our study was to evaluate the impact of preoperative eGFR levels on short-term post-operative outcomes in patients undergoing pancreatectomy.

Methods

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) pancreatectomy file (2014–2017) was queried for all adult patients (age ≥ 18) who underwent pancreatic resection. Patients were stratified into two groups based on their preoperative eGFR (eGFR < 60 mL/min/1.73m2 and eGFR ≥ 60 mL/min/1.73m2). Outcome measures included post-operative pancreatic fistula, discharge disposition, hospital length of stay, 30-day readmission rate, and 30-day morbidity and mortality. Multivariate logistic regression analysis was performed.

Results

A total of 21,148 were included in the study of which 12% (n = 2256) had preoperative eGFR < 60 mL/min/1.73m2. Patients in the eGFR < 60 group had prolonged length of stay, were less likely to be discharged home, had higher minor and major complication rates, and higher rates of mortality. On logistic regression analysis, lower preoperative eGFR (< 60 mL/min/1.73m2) was associated with higher odds of prolonged length of stay [aOR: 1.294 (1.166–1.436)], adverse discharge disposition [aOR: 1.860 (1.644–2.103)], minor [aOR: 1.460 (1.321–1.613)] and major complications [aOR: 1.214 (1.086–1.358)], bleeding requiring transfusion [aOR: 1.861 (1.656–2.091)], and mortality [aOR: 2.064 (1.523–2.797)].

Conclusion

Preoperative decreased renal function measured by eGFR is associated with adverse outcomes in patients undergoing pancreatic resection. The results of this study may be valuable in improving preoperative risk stratification and post-operative expectations.

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Authors and Affiliations

  1. University of Arizona College of Medicine, Tucson, AZ, USA

    Mohammad Hamidi, Catherine L. O’Grady, Sacha D. Brown, Amanda K. Arrington, Lilah Morris-Wiseman, Taylor S. Riall & Mohammad Khreiss

  2. Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85724-5131, USA

    Mohammad Khreiss

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Appendix

Appendix

  1. 1)

    Pancreaticoduodenectomy (Whipple)

    48,150/48152: Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy, and gastrojejunostomy (Whipple-type procedure)

    48,153/48153: Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type procedure)

  2. 2)

    Distal Pancreatectomy

    48,140/48145: Pancreatectomy, distal subtotal, with or without splenectomy

    48,146: Pancreatectomy, distal, near-total with preservation of duodenum (Child-type procedure)

  3. 3)

    Other procedures:

    48,148: Excision of ampulla of Vater

    48,120: Excision Procedures on the Pancreas

    48,155: Excision Procedures on the Pancreas

    48,999: Other Procedures on the Pancreas

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Hamidi, M., O’Grady, C.L., Brown, S.D. et al. Does Preoperative Estimated Glomerular Filtration Rate (eGFR) Predict Short-Term Surgical Outcomes in Patients Undergoing Pancreatic Resections?. J Gastrointest Surg 26, 861–868 (2022). https://doi.org/10.1007/s11605-021-05179-8

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  • DOI: https://doi.org/10.1007/s11605-021-05179-8

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