Key result
Both low (<30 mL/min/1.73 m2, OR 1.82) and very high (≥120 mL/min/1.73 m2, OR 1.28) pre-operative estimated GFR were associated with a significantly higher risk of post-operative pulmonary complications compared to normal eGFR.
Why the study?
Does abnormal pre-operative eGFR increase post-operative pulmonary complications in patients undergoing laparoscopic surgery?
Cohort (n=425,213)
Yes
Does abnormal pre-operative eGFR increase post-operative pulmonary complications in patients undergoing laparoscopic surgery?
Both low (<60 mL/min/1.73 m2) and very high (≥120 mL/min/1.73 m2) pre-operative eGFR are associated with an increased risk of post-operative pulmonary complications after laparoscopic surgery.
Answers are grounded in this paper and cite their sources.
Abnormal pre-op eGFR may flag higher PPC risk after laparoscopic surgery; leaves open whether optimization alters outcomes.
Despite a large body of evidence showing the pandemic of chronic kidney disease, the impact of pre-operative kidney function on the risk of post-operative pulmonary complications (PPCs) is not well known. We used multivariable logistic regression analyses with 3-level hierarchical adjustments to identify the association of pre-operative estimated glomerular filtration rate (eGFR) with PPCs in laparoscopic surgeries. Among 452,213 patients between 2005 and 2013 in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database, a total of 3,727 patients (0.9%) experienced PPCs. We found a gradient association between lower eGFR and higher likelihood of PPCs in the unadjusted model. In the case-mix adjusted model, a reverse-J-shaped association was observed; a small albeit significant association with the highest eGFR category emerged. Further adjustment slightly attenuated these associations, but the PPCs risk in the eGFR groups of <30, 30–60, and ≥120 mL/min/1.73 m2 remained significant: odds ratios (95% confidence intervals) of 1.82 (1.54–2.16), 1.38 (1.24–1.54), and 1.28 (1.07–1.53), respectively (reference: 90–120 mL/min/1.73 m2). Our findings propose a need for careful pre-operative evaluation of cardiovascular and pulmonary functions and post-operative fluid management among patients with not only lower but also very high eGFR.
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Shimomura et al. (2017) conducted a cohort in Patients undergoing laparoscopic surgeries (n=425,213). Pre-operative estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 vs. eGFR 90 to <120 mL/min/1.73 m2 was evaluated on Post-operative pulmonary complications (pneumonia, unplanned intubation, or on ventilator for over 48 hours) within 30 days (OR 1.82, 95% CI 1.54-2.16, p=<0.001). Both low (<30 mL/min/1.73 m2, OR 1.82) and very high (≥120 mL/min/1.73 m2, OR 1.28) pre-operative estimated GFR were associated with a significantly higher risk of post-operative pulmonary complications compared to normal eGFR.
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