Abstract
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.
Highlights
Chronic kidney disease (CKD), characterized by decreased kidney function, is a major national and international public health issue with an estimated prevalence of 13.6% in the United States[6]
We examined our hypothesis that patients with pre-operative kidney function would have higher incidence of pulmonary complications (PPCs) after laparoscopic surgery by using the ACS-NSQIP database
There was a significant trend in the risk of non-pulmonary infectious complications across estimated glomerular filtration rate (eGFR) categories (Ptrend < 0.001 in all adjustment models), the risk associated with eGFR categories was much smaller compared to PPCs;
Summary
Chronic kidney disease (CKD), characterized by decreased kidney function, is a major national and international public health issue with an estimated prevalence of 13.6% in the United States[6]. There are scarce data on the relationship between pre-operative kidney function and PPCs. Laparoscopy has been employed in many surgical procedures to reduce post-operative complications and promote patient recovery[7]. Of the diaphragm and accelerates atelectasis formation[10], which decreases respiratory compliance and arterial oxygenation[11, 12]. These unfavorable conditions may be aggravated in the presence of CKD. We examined our hypothesis that patients with pre-operative kidney function would have higher incidence of PPCs after laparoscopic surgery by using the ACS-NSQIP database. We evaluated the association with non-pulmonary infectious complications in order to contrast the relative contribution of kidney function to different subtypes of post-operative complications
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