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Postoperative changes in serum creatinine. When do they occur and how much is important?
M E Charlson1, C R MacKenzie, J P Gold
1Department of Medicine, Cornell University Medical College, New York, New York 10021.
Annals of Surgery
|March 1, 1989
Summary
Serum creatinine effectively monitors postoperative renal function in patients, particularly those with hypertension and diabetes. Early detection of elevated serum creatinine levels can identify patients at risk for sustained kidney impairment after surgery.
Area of Science:
- Nephrology
- Surgical Patient Monitoring
- Renal Function Assessment
Background:
- Postoperative renal function is critical for patient outcomes.
- Hypertension and diabetes are common comorbidities increasing renal risk.
- Accurate monitoring of kidney function post-surgery is essential.
Purpose of the Study:
- To assess the utility of serum creatinine in tracking postoperative renal function.
- To identify early indicators of renal impairment after noncardiac surgery.
- To correlate serum creatinine changes with creatinine clearance postoperatively.
Main Methods:
- Prospective study of 278 patients undergoing noncardiac surgery.
- Daily serum creatinine monitoring from postoperative day 1 to 6.
- Preoperative and postoperative (day 4-5) creatinine clearance evaluation.
Main Results:
- 23% of patients showed a ≥20% increase in serum creatinine within 6 days.
- 12% experienced sustained (≥48 hours) creatinine elevation.
- Sustained elevation identified patients at risk for renal failure and discharge impairment.
Conclusions:
- Serum creatinine is a valuable tool for monitoring postoperative renal function.
- Early and sustained serum creatinine increases signal potential renal complications.
- Creatinine clearance changes were largely reflected by serum creatinine, with exceptions in amputation patients.