Key result
Preoperative eGFR under 60 is not associated with increased 30-day complications in GI surgery.
Why the study?
Does preoperative renal dysfunction increase the risk of 30-day postoperative complications in patients undergoing elective gastrointestinal surgeries?
Cohort (n=370)
No
Does preoperative renal dysfunction increase the risk of 30-day postoperative complications in patients undergoing elective gastrointestinal surgeries?
Unlike in cardiac and vascular surgeries, preoperative renal dysfunction does not appear to increase 30-day postoperative complications following elective gastrointestinal surgeries.
Answers are grounded in this paper and cite their sources.
Preoperative eGFR <60 ml/min/1.73 m² was not linked to higher 30-day complications after elective GI surgery; hypothesis-generating and should not yet change risk stratification.
Background . Preoperative risk stratification and optimising care of patients undergoing elective surgery are important to reduce the risk of postoperative outcomes. Renal dysfunction is becoming increasingly prevalent, but its impact on patients undergoing elective gastrointestinal surgery is unknown although much evidence is available for cardiac surgery. This study aimed to investigate the impact of preoperative estimated glomerular filtration rate (eGFR) and postoperative outcomes in patients undergoing elective gastrointestinal surgeries. Methods . This prospective study included consecutive adult patients undergoing elective gastrointestinal surgeries attending preassessment screening (PAS) clinics at the Queen Elizabeth Hospital Birmingham (QEHB) between July and August 2016. Primary outcome measure was 30-day overall complication rates and secondary outcomes were grade of complications, 30-day readmission rates, and postoperative care setting. Results . This study included 370 patients, of which 11% (41/370) had eGFR of <60 ml/min/1.73 m 2 . Patients with eGFR < 60 ml/min/1.73 m 2 were more likely to have ASA grade 3/4 (p<0.001) and >2 comorbidities (p<0.001). Overall complication rates were 15% (54/370), with no significant difference in overall (p=0.644) and major complication rates (p=0.831) between both groups. In adjusted models, only surgery grade was predictive of overall complications. Preoperative eGFR did not impact on overall complications (HR: 0.89, 95% CI: 0.45–1.54; p=0.2). Conclusions . Preoperative eGFR does not appear to impact on postoperative complications in patients undergoing elective gastrointestinal surgeries, even when stratified by surgery grade. These findings will help preassessment clinics in risk stratification and optimisation of perioperative care of patients.
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Kamarajah et al. (2018) conducted a cohort in Elective gastrointestinal and hepatopancreatobiliary surgeries (n=370). Preoperative renal dysfunction (eGFR < 60 ml/min/1.73 m2) vs. Preoperative eGFR ≥ 60 ml/min/1.73 m2 was evaluated on 30-day overall complication rates (HR 0.89, 95% CI 0.45-1.54, p=0.200). Preoperative estimated glomerular filtration rate < 60 ml/min/1.73 m2 was not associated with increased 30-day overall complications following elective gastrointestinal surgeries (HR 0.89, 95% CI 0.45-1.54).
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