Loria Anthony, Glance Laurent G, Melucci Alexa D, Boodry Courtney, Justiniano Carla F, Dunne Richard F, Mustian Karen M, Becerra Adan Z, Jusko Todd A, Temple Larissa K, Fleming Fergal J
Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York.
Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Ann Surg. 2023 Feb 1;277(2):246-251. doi: 10.1097/SLA.0000000000005760. Epub 2022 Nov 28.
To assess the association between low preoperative serum creatinine and postoperative outcomes.
The association between low creatinine and poor surgical outcomes is not well understood.
We identified patients with creatinine in the 7 days preceding nonemergent inpatient surgery in the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2020. Multivariable logistic regression was used to examine the association between creatinine and 30-day mortality and major complications.
Of 1,809,576 patients, 27.8% of males and 23.5% of females had low preoperative serum creatinine, 14.6% experienced complications, and 1.2% died. For males, compared with the reference creatinine of 0.85 to 1.04, those with serum creatinine ≤0.44 had 55% increased odds of mortality [ adjusted odds ratio (aOR), 1.55; 95% CI, 1.29-1.86] and 82% increased odds of major complications (aOR, 1.82; 95% CI, 1.69-1.97). Similarly, for females, compared with the reference range of 0.65 to 0.84, those with serum creatinine ≤0.44 had 49% increased odds of mortality (aOR, 1.49; 95% CI, 1.32-1.67) and 76% increased odds of major complications (aOR, 1.76; 95% CI, 1.70-1.83). These associations persisted for the total cohort, among those with mildly low albumin, and for those with creatinine values measured 8 to 30 days preoperatively.
A low preoperative creatinine is common and associated with poor outcomes after nonemergent inpatient surgery. A low creatinine may help identify high-risk patients who may benefit from further evaluation and optimization.
评估术前血清肌酐水平低与术后结局之间的关联。
肌酐水平低与手术预后不良之间的关联尚未完全明确。
我们在美国外科医师学会国家外科质量改进计划数据库中，识别出2005年至2020年非急诊住院手术前7天内肌酐检测的患者。采用多变量逻辑回归分析肌酐水平与30天死亡率及主要并发症之间的关联。
在1,809,576例患者中，27.8%的男性和23.5%的女性术前血清肌酐水平低，14.6%发生并发症，1.2%死亡。对于男性，与肌酐参考值0.85至1.04相比，血清肌酐≤0.44者死亡率增加55%[校正比值比（aOR），1.55；95%置信区间（CI），1.29 - 1.86]，主要并发症发生率增加82%（aOR，1.82；95%CI，1.69 - 1.97）。同样，对于女性，与肌酐参考范围0.65至0.84相比，血清肌酐≤0.44者死亡率增加49%（aOR，1.49；95%CI，1.32 - 1.67），主要并发症发生率增加76%（aOR，1.76；95%CI，1.70 - 1.83）。这些关联在整个队列、轻度低白蛋白患者以及术前8至30天测量肌酐值的患者中均持续存在。
术前肌酐水平低很常见，且与非急诊住院手术后的不良结局相关。低肌酐水平可能有助于识别可能从进一步评估和优化中获益的高危患者。
