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Does Chronic Kidney Disease Affect Outcomes after Major Abdominal Surgery? Results from the National Surgical Quality Improvement Program

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

The impact of chronic kidney disease (CKD) and end-stage renal disease on outcomes following major abdominal surgery is not well defined.

Materials and 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 m2), even modest CKD (GFR, 45–60 ml/min/1.73 m2) 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 m2 and OR, 2.84; GFR, 15–30 ml/min/1.73 m2 and OR, 5.56). In addition, CKD was independently associated with increased postoperative complications.

Conclusion

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.

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Authors and Affiliations

  1. Department of Surgery, Stanford University, 300 Pasteur Dr, MC5641, Stanford, CA, 94305, USA

    Jordan M. Cloyd, Yifei Ma, John M. Morton, George A. Poultsides & Brendan C. Visser

  2. Division of Nephrology, Department of Medicine, Stanford University, Stanford, CA, USA

    Manjula Kurella Tamura

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  1. Jordan M. Cloyd
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  2. Yifei Ma
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Correspondence to Brendan C. Visser.

Appendix

Appendix

CPT codes queried to identify 28,489 major abdominal operations

Organ system

CPT codes

Esophagus

43107–8, 43113, 43116–8, 4312–3

Stomach

43210, 43611, 43620, 43622, 43631-4

Hepatobiliary

47120, 47122, 47125, 47130, 47711–2

Pancreas

48140, 48145, 48146, 48148, 48150, 48152–5, 48160

Colon

44140–1, 44143–7, 44150–1, 44155–8, 44160, 44204–8, 44210–2

Rectal

45110–4, 45119–45121, 45126, 45395, 45397

Peritoneal

49203–5, 49255

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Cloyd, J.M., Ma, Y., Morton, J.M. et al. Does Chronic Kidney Disease Affect Outcomes after Major Abdominal Surgery? Results from the National Surgical Quality Improvement Program. J Gastrointest Surg 18, 605–612 (2014). https://doi.org/10.1007/s11605-013-2390-3

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  • DOI: https://doi.org/10.1007/s11605-013-2390-3

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