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Are postoperative complications more common following colon and rectal surgery in patients with chronic kidney
J Canedo1, K Ricciardi, G DaSilva
1Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
Insights
Patients with chronic kidney disease (CKD) Stages 3 and 4 experienced more postoperative infections after colorectal surgery. Careful preoperative optimization is crucial for managing CKD patients undergoing surgery.
Area of Science:
- Nephrology
- Surgical Oncology
- Anesthesiology
Background:
- Chronic kidney disease (CKD) stages are defined by estimated glomerular filtration rate (eGFR).
- National Kidney Foundation guidelines recommend eGFR for early CKD detection.
- CKD Stages 3 and 4 represent moderate to severe kidney impairment.
Purpose of the Study:
- To assess postoperative complications in patients with CKD Stages 3 and 4 undergoing colorectal surgery (CRS).
- To compare outcomes between CKD patients and matched controls without significant kidney disease.
Main Methods:
- Retrospective analysis of a surgical database.
- CKD group (eGFR 15-59 ml/min) compared with American Society of Anesthesiology (ASA) score-matched controls (eGFR ≥ 60 ml/min).
- Data collected included demographics, comorbidities, operative details, and 30-day postoperative outcomes.
Main Results:
- CKD patients were older and had lower BMI than controls.
- No significant differences in ASA scores or length of stay.
- Higher incidence of postoperative infection in the CKD group (60% vs. 40%); no difference in reoperation, readmission, or acute renal failure (ARF).
Conclusions:
- CKD Stages 3 and 4 patients face increased postoperative infection risk after colorectal surgery.
- Acute renal failure (ARF) occurred in 18.6% of CKD patients.
- Preoperative optimization, including hydration and careful medication selection, is vital for this patient group.
Aim:
According to National Kidney Foundation guidelines, early stages of chronic kidney disease (CKD) can be detected through the estimated glomerular filtration rate (eGFR). We assessed complications following colorectal surgery (CRS) in patients with CKD Stages 3 and 4, as defined by the eGFR.
Method:
Patients with CKD were identified within our database. Patients with an eGFR of 15-59 ml/min (CKD Stages 3 and 4) formed the CKD group and were compared with American Society of Anesthesiology (ASA) score-matched controls with an eGFR of ≥ 60 ml/min. Assessments included demographics, comorbidity, ASA score, operative details and 30-day postoperative outcome.
Results:
Seventy patients in the CKD group were matched with 70 controls. ASA scores and length of stay did not differ significantly between the groups. CKD patients were older (mean age 76.5 years vs 71.1 years; P < 0.001) and had a lower mean body mass index (24.3 vs 28.2; P < 0.001) compared with controls. Compared with the CKD group, the mean operation time was longer in the control group (181.5 min vs 151.6 min; P = 0.02) and the estimated blood loss was greater (232 ml vs 165 ml; P = 0.004). Postoperative infection was more common in the CKD group (60%vs 40%; P = 0.01). There were no significant differences in reoperation rates, 30-day readmissions or the incidence of acute renal failure (ARF).
Conclusion:
Patients with CKD Stages 3 and 4 had a higher incidence of postoperative infections than matched controls after colorectal surgery. ARF developed in 18.6% of patients. Preoperative optimization should include adequate hydration and assessment of potentially nephrotoxic substances for bowel preparation, preoperative antibiotics and pain control.
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