Journal article
Chronic Kidney Disease Classification Predicts Short-Term Outcomes of Patients Undergoing Pancreaticoduodenectomy
Journal of gastrointestinal surgery, Vol.26(12), pp.2534-2541
12/01/2022
DOI: 10.1007/s11605-022-05512-9
PMID: 36344795
Abstract
The impact of chronic kidney disease (CKD) on pancreaticoduodenectomy has not been well established. In this study, we investigated the effects of preoperative CKD in patients undergoing pancreaticoduodenectomy.
A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database identified patients who underwent pancreaticoduodenectomy between 2015 and 2019. The estimated glomerular filtration rate (eGFR) for each patient was calculated using the CKD-Epidemiology Collaborative (CKD-EPI) 2021 equation. Kidney function was stratified according to the Kidney Disease: Improving Global Outcomes (KDIGO) Classification: G1, normal/high function (estimated glomerular filtration rate ≥ 90 ml/min/1.73 m
); G2-G3, mild/moderate CKD (89-30 ml/min/1.73 m
); and G4-G5, severe CKD (≤ 29 ml/min/1.73 m
). The 30-day overall complications and outcomes were compared using regression models accounting for demographics and comorbidities.
A total of 20,656 (55.7% men) patients were identified. Univariate analysis showed that compared to G1 patients, G2-G3 and G4-G5 had higher rates of overall complications (p < 0.001), need for readmission (p = 0.004), need for reoperation (p < 0.001), discharge to the care facility (p < 0.001), death (p < 0.001), and average length of stay (p < 0.001). On multivariable regression, G2-G3 renal function was found to be an independent risk factor for overall (1.10 [1.04-1.17], p = 0.002), pulmonary (1.23 [1.10-1.37], p < 0.001), hematologic (1.08 [1.02-1.16], p = 0.015), and renal (1.29 [1.11-1.49], p < 0.001) complications; discharge to care facility (1.10 [1.02-1.19], p = 0.045); and 30-day mortality (1.25 [1.01-1.56], p = 0.045). G4-G5 renal function was a predictor of worse outcomes for the prior variables and an independent risk factor for cardiovascular complications (2.70 [1.44-4.96], p = 0.001) and length of stay (1.32 [1.13-1.56], p < 0.001).
The degree of CKD was related to the overall complications and outcomes after pancreaticoduodenectomy. Therefore, the CKD classification should be strongly considered in the preoperative risk stratification of these patients.
Details
- Title: Subtitle
- Chronic Kidney Disease Classification Predicts Short-Term Outcomes of Patients Undergoing Pancreaticoduodenectomy
- Creators
- Ronit Patnaik - The University of Texas at San AntonioMustafa Tamim Alam Khan - Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USAInce Spencer - Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USAHassan Aziz - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Journal of gastrointestinal surgery, Vol.26(12), pp.2534-2541
- DOI
- 10.1007/s11605-022-05512-9
- PMID
- 36344795
- ISSN
- 1091-255X
- eISSN
- 1873-4626
- Grant note
- T32 CA148724 / NCI NIH HHS
- Language
- English
- Date published
- 12/01/2022
- Academic Unit
- Surgery
- Record Identifier
- 9984701549902771
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