Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside Building Suite 4954, Cleveland, OH, 44106, USA.
Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Int Urol Nephrol. 2022 Jan;54(1):1-7. doi: 10.1007/s11255-021-03068-2. Epub 2021 Nov 27.
To assess the impact of preoperative chronic kidney disease (CKD) on perioperative morbidity and mortality in a contemporary cohort undergoing renal surgery in an era of increased prevalence of minimally invasive surgery and partial nephrectomy.
The National Surgery Quality Improvement Program dataset was queried to identify patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) between 2010 and 2018. CKD staging was assigned based on creatinine clearance calculated using the Cockcroft-Gault formula. Multivariable logistic regression was performed to assess the effect of preoperative CKD stage on postoperative outcomes, including a composite variable encompassing multiple major complications.
We analyzed 19,545 patients with CKD undergoing renal surgery. CKD stage ≥ 2 predicted an increase in major perioperative complications, OR 1.54 (95% CI 1.46-1.63); p < 0.01. The risk of perioperative morbidity increased linearly with increasing CKD stage. Patients with CKD stage > 2 also demonstrated increased 30-day mortality, OR 1.87 (95% CI 1.26-2.48); p < 0.01. Adjusting for surgery type, CKD staging predicted perioperative mortality in patients undergoing RN only, and perioperative morbidity in RN and PN.
Here, we demonstrate a statistically significant increase in the risk of major postoperative complications following RN and PN with increasing CKD stage. Amongst patients undergoing RN, we also demonstrate increasing 30-day mortality with increasing CKD stage. Importantly, we highlight the ability of CKD staging to predict major perioperative outcomes with greater magnitude of effect than surgery type alone. Thus, we provide a model for translating CKD staging into operative risk amongst patients undergoing surgery for a renal mass.
在微创外科和部分肾切除术普及的时代，评估术前慢性肾脏病（CKD）对接受肾切除术患者围手术期发病率和死亡率的影响。
通过国家手术质量改善计划数据集，确定了 2010 年至 2018 年期间接受根治性肾切除术（RN）或部分肾切除术（PN）的患者。根据 Cockcroft-Gault 公式计算的肌酐清除率对 CKD 分期进行赋值。采用多变量逻辑回归评估术前 CKD 分期对术后结局的影响，包括涵盖多种主要并发症的复合变量。
我们分析了 19545 例患有 CKD 的接受肾手术的患者。CKD 分期≥2 预测主要围手术期并发症的发生率增加，OR 为 1.54（95%CI 1.46-1.63）；p<0.01。随着 CKD 分期的增加，围手术期发病率的风险呈线性增加。CKD 分期>2 的患者还表现出 30 天死亡率增加，OR 为 1.87（95%CI 1.26-2.48）；p<0.01。调整手术类型后，CKD 分期仅在接受 RN 的患者中预测围手术期死亡率，在接受 RN 和 PN 的患者中预测围手术期发病率。
在此，我们证明了随着 CKD 分期的增加，接受 RN 和 PN 后发生重大术后并发症的风险显著增加。在接受 RN 的患者中，我们还发现随着 CKD 分期的增加，30 天死亡率也随之增加。重要的是，我们强调了 CKD 分期预测重大围手术期结局的能力，其预测效果的幅度大于手术类型。因此，我们为在患有肾脏肿块的患者中进行手术时，将 CKD 分期转化为手术风险提供了一个模型。
