The effect of preoperative renal insufficiency on postoperative outcomes after major hepatectomy: a multi-institutional analysis of 1,170 patients.

Autor:	Squires MH 3rd; Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA., Lad NL; Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA., Fisher SB; Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA., Kooby DA; Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA., Weber SM; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI., Brinkman A; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI., Scoggins CR; Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY., Egger ME; Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY., Cardona K; Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA., Cho CS; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI., Martin RC; Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY., Russell MC; Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA., Winslow E; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI., Staley CA; Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA., Maithel SK; Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA. Electronic address: smaithe@emory.edu.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Surgeons [J Am Coll Surg] 2014 Nov; Vol. 219 (5), pp. 914-22. Date of Electronic Publication: 2014 Jun 19.
DOI:	10.1016/j.jamcollsurg.2014.05.015
Abstrakt:	Background: Renal insufficiency adversely affects outcomes after cardiac and vascular surgery. The effect of preoperative renal insufficiency on outcomes after major hepatectomy is unknown. Study Design: All patients who underwent major hepatectomy (≥3 segments) at 3 institutions from 2000 to 2012 were identified. Resections were performed using low central venous pressure anesthesia. Renal function was analyzed by preoperative serum creatinine (sCr) level. Primary outcomes were major complications (Clavien grade III to V), respiratory failure, renal failure requiring hemodialysis, and 90-day mortality. Results: One thousand one hundred and seventy patients had preoperative sCr levels available. Renal function was analyzed using sCr dichotomized at 1.8 mg/dL, 1 SD higher than the mean value (0.97 ± 0.79 mg/dL) for the cohort. Twenty-two patients had sCr ≥1.8 mg/dL. Major complications occurred in 279 patients (23.8%), respiratory failure in 62 (5.3%), and renal failure in 31 (2.6%). Ninety-day mortality rate was 5.4%. On multivariate analysis, patients with sCr ≥1.8 mg/dL remained at significantly increased risk for major complications (hazard ratio = 3.94; 95% CI, 1.48-10.49; p = 0.006), respiratory failure (hazard ratio = 4.43; 95% CI, 1.33-14.80; p = 0.014), and renal failure (hazard ratio = 4.75; 95% CI, 1.19-18.97; p = 0.028). Serum Cr ≥1.8 mg/dL was not independently associated with 90-day mortality on multivariate analysis (p = 0.27). Conclusions: Preoperative serum creatinine ≥1.8 mg/dL identifies patients at significantly increased risk of postoperative major complications, respiratory failure, and renal failure requiring dialysis. Patients are well selected for major hepatectomy, and few patients with substantial renal insufficiency are deemed operative candidates. (Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu