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Modest serum creatinine elevation affects adverse outcome after general surgery
Maureen M O'Brien1, Ralph Gonzales, A Laurie Shroyer
1Division of Cardiac Research, Denver Veterans Affairs Medical Center, Colorado, USA.
Insights
Elevated preoperative serum creatinine levels (over 1.5 mg/dL) significantly predict increased morbidity and mortality risk in general surgery patients. This readily available marker helps identify individuals at higher risk for adverse outcomes.
Area of Science:
- Nephrology
- Surgical Outcomes Research
- Public Health
Background:
- Previous studies linked modest preoperative serum creatinine elevation (1.5-3.0 mg/dL) to adverse outcomes in cardiac surgery.
- The applicability of this finding to general surgery populations remained unclear.
Purpose of the Study:
- To investigate the association between preoperative serum creatinine levels and postoperative morbidity and mortality in patients undergoing general surgery.
- To determine if a serum creatinine threshold of 1.5 mg/dL is predictive of adverse outcomes in this population.
Main Methods:
- Analysis of 49,081 major general surgery cases from the Veterans Affairs National Surgical Quality Improvement Program (1996-1998).
- Multivariable logistic regression models were used to assess the impact of 46 risk variables, including serum creatinine.
- Patients were stratified based on preoperative serum creatinine levels: 1.5-3.0 mg/dL and >3.0 mg/dL.
Main Results:
- Serum creatinine >1.5 mg/dL was significantly associated with higher 30-day mortality (adjusted OR 1.44 for 1.5-3.0 mg/dL, 1.93 for >3.0 mg/dL).
- Increased morbidity (one or more complications) was also observed with elevated creatinine (adjusted OR 1.18 for 1.5-3.0 mg/dL).
- A preoperative serum creatinine level exceeding 1.5 mg/dL emerged as a critical threshold for increased risk.
Conclusions:
- Modest preoperative serum creatinine elevation (>1.5 mg/dL) is a significant, independent predictor of risk-adjusted morbidity and mortality following general surgery.
- Preoperative serum creatinine serves as a practical and accessible biomarker for identifying patients at elevated risk of adverse surgical outcomes.
Background:
Modest preoperative serum creatinine elevation (1.5 to 3.0 mg/dL) has been recently shown to be independently associated with morbidity and mortality after cardiac surgery. It is important to know if this association can be applied more broadly to general surgery cases.
Methods:
Multivariable logistic regression analyses of 46 risk variables in 49,081 cases from the Veterans Affairs National Surgical Quality Improvement Program, undergoing major general surgery from 10/1/96 through 9/30/98.
Results:
Thirty day mortality and several cardiac, respiratory, infectious and hemorrhagic morbidities were significantly (P < 0.001) higher in patients with a serum creatinine>1.5 mg/dL. With multivariable analysis, the adjusted odds ratio for mortality for patients with a serum creatinine of 1.5 to 3.0 mg/dL was 1.44 [95% confidence interval (95% CI) 1.22 to 1.71] and for creatinine>3.0 mg/dL was 1.93 (95% CI 1.51 to 2.46). The adjusted odds ratio for morbidity (one or more postoperative complications) for patients with a serum creatinine of 1.5 to 3.0 mg/dL was 1.18 (95% CI 1.06 to 1.32) and for creatinine>3.0 mg/dL was 1.19 (95% CI 0.99 to 1.43). Further stratification and recursive partitioning of creatinine levels revealed that a serum creatinine level>1.5 mg/dL was the approximate threshold for both increased morbidity and mortality.
Conclusions:
Modest preoperative serum creatinine elevation (>1.5 mg/dL) is a significant predictor of risk-adjusted morbidity and mortality after general surgery. A preoperative serum creatinine of 1.5 mg/dL or higher is a readily available marker for potential adverse outcomes after general surgery.