Chalfant Victor, Riveros Carlos, Stec Andrew A
Division of Urology, SIU School of Medicine, Springfield, IL, USA.
Department of Urology, Houston Methodist Hospital, Houston, TX, USA.
Curr Urol. 2025 May;19(3):224-229. doi: 10.1097/CU9.0000000000000234. Epub 2024 Mar 12.
Renal protection is a frequent indication for urological surgery in pediatric patients; however, preoperative assessment is not routinely performed. We assessed the rates of preoperative renal function testing and stratified outcomes after major pediatric urological surgery. Pediatric urology patients, specifically high-risk patients undergoing genitourinary surgeries, are likely to have an underdiagnosis of renal dysfunction after surgery.
Cases were identified from the 2012 to 2019 National Surgical Quality Improvement Program-Pediatric database. Patients who underwent major urological surgery on an inpatient basis were included in this study. Abnormal renal function was defined as a creatinine (Cr) level of ≥0.5 mg/dL (younger than 2 years) and a glomerular filtration rate of <90 mL/min (2 years or older). Glomerular filtration rate was calculated using the bedside Schwartz equation (2 years or older): estimated glomerular filtration rate = 0.413 × (height/Cr).
A total of 17,315 patients were included, of whom 3792 (21.9%) had documented Cr values. Based on the defined criteria, abnormal renal function was found in 7.3% of infants (younger than 2 years), 6.3% of children (2-9 years), and 15.0% of adolescents (10-18 years). Patients with abnormal preoperative renal function values were significantly ( < 0.001) more likely to experience readmission (10.2% vs. 5.8%), reoperation (3.7% vs. 1.6%), surgical organ/space infection (0.9% vs. 0.4%), transfusion (1.5% vs. 0.6%), renal insufficiency (1.6% vs. 0.4%), or urinary tract infection (5.1% vs. 3.6%).
In this pediatric population, 21.9% of the patients had documented preoperative Cr values before major urological surgery. Patients with documented abnormal preoperative renal function tests experienced higher complication rates. These patients have higher rates of progressive renal insufficiency and acute renal failure than those with normal renal function. The introduction of a standardized and unbiased risk assessment tool has the potential to offer patients benefits by pinpointing individuals with a heightened risk of complications. Further investigation is necessary to enhance the precise categorization of at-risk patients.
肾脏保护是儿科患者泌尿外科手术的常见指征；然而，术前评估并非常规进行。我们评估了小儿泌尿外科大手术后术前肾功能检测的比例及分层结局。小儿泌尿外科患者，尤其是接受泌尿生殖系统手术的高危患者，术后肾功能不全可能未被充分诊断。
病例来自2012年至2019年国家外科质量改进计划 - 儿科数据库。纳入在住院期间接受泌尿外科大手术的患者。肾功能异常定义为肌酐（Cr）水平≥0.5mg/dL（2岁以下）以及肾小球滤过率<90mL/min（2岁及以上）。肾小球滤过率使用床边施瓦茨公式（2岁及以上）计算：估计肾小球滤过率 = 0.413×（身高/Cr）。
共纳入17315例患者，其中3792例（21.9%）有记录的Cr值。根据既定标准，7.3%的婴儿（2岁以下）、6.3%的儿童（2 - 9岁）和15.0%的青少年（10 - 18岁）存在肾功能异常。术前肾功能值异常的患者再次入院（10.2%对5.8%）、再次手术（3.7%对1.6%）、手术部位/腔隙感染（0.9%对0.4%）、输血（1.5%对0.6%）、肾功能不全（1.6%对0.4%）或尿路感染（5.1%对3.6%）的可能性显著更高（<0.001）。
在这个儿科人群中，21.9%的患者在泌尿外科大手术前有记录的术前Cr值。术前肾功能检测异常的患者并发症发生率更高。这些患者进行性肾功能不全和急性肾衰竭的发生率高于肾功能正常的患者。引入标准化且无偏倚的风险评估工具有可能通过精准识别并发症风险较高个体使患者受益。有必要进一步研究以加强对高危患者的精确分类。
