Chronic kidney disease and perioperative outcomes in urological oncological surgery

• Published in: International journal of urology Vol. 21; no. 12; pp. 1245 - 1252
• Main Authors: Schmid, Marianne, Ravi, Praful, Abd-El-Barr, Abd-El-Rahman M, Klap, Julia, Sammon, Jesse D, Chang, Steven L, Menon, Mani, Kibel, Adam S, Fisch, Margit, Trinh, Quoc-Dien
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-12-2014
• Subjects: Adolescent; Adult; Aged; chronic kidney disease; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Minimally Invasive Surgical Procedures; Odds Ratio; perioperative outcome; Postoperative Complications - epidemiology; Prognosis; radical and partial nephrectomy; radical cystectomy; radical prostatectomy; Renal Insufficiency, Chronic - etiology; Retrospective Studies; Survival Rate - trends; United States - epidemiology; Urologic Neoplasms - complications; Urologic Neoplasms - surgery; Urologic Surgical Procedures; Young Adult; United States; perioperative outcome; radical cystectomy; chronic kidney disease; radical prostatectomy; radical and partial nephrectomy
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.12563

Objectives
To evaluate baseline renal dysfunction among patients undergoing urological oncological surgery and its impact on early postoperative outcomes.
Methods
Between 2005 and 2011, patients who underwent minimally‐invasive or open radical prostatectomy, partial nephrectomy and radical nephrectomy, or open radical cystectomy, respectively, were identified in the National Surgical Quality Improvement Program dataset. Preoperative kidney function was assessed using estimated glomerular filtration rate and staged according to National Kidney Foundation definitions. Multivariable logistic regression was used to model the association between preoperative renal function and the risk of 30‐day mortality and major complications. Furthermore the impact of chronic kidney disease on operation time and length of hospital stay was assessed.
Results
Overall, 13 168 patients underwent radical prostatectomy (65.4%), partial nephrectomy (10.7%) and radical nephrectomy (16.1%) and radical cystectomy (7.8%), respectively; 50.1% of evaluable patients had reduced kidney function (chronic kidney disease II), and a further 12.6, 0.7 and 0.9% were respectively classified into chronic kidney disease stages III, IV, and V. Chronic kidney disease was an independent predictor of 30‐day major postoperative complications (chronic kidney disease III: odds ratio 1.61, P < 0.001; chronic kidney disease IV: odds ratio 2.24, P = 0.01), of transfusions (chronic kidney disease III: odds ratio 2.14, P < 0001), of prolonged length of stay (chronic kidney disease III: odds ratio 2.61, P < 0.001; chronic kidney disease IV: odds ratio 3.37, P < 0.001; and chronic kidney disease V: odds ratio 1.68; P = 0.03) and of 30‐day mortality (chronic kidney disease III: odds ratio 4.15, P = 0.01; chronic kidney disease IV: odds ratio 10.10, P = 0.003; and chronic kidney disease V: odds ratio 17.07, P < 0.001) compared with patients with no kidney disease.
Conclusions
Renal dysfunction might be underrecognized in patients undergoing urological cancer surgery. Chronic kidney disease stages III, IV and V are independent predictors for poor 30‐day postoperative outcomes.