Renal function in pediatric urologic surgical patients: Insight from the National Surgical Quality Improvement
Victor Chalfant1, Carlos Riveros2, Andrew A Stec3
1Division of Urology, SIU School of Medicine, Springfield, IL, USA.
Insights
Preoperative renal function testing is crucial for pediatric urological surgery. Patients with abnormal results face higher complication risks, highlighting the need for better risk assessment.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Renal protection is a key reason for pediatric urological surgery, yet preoperative renal function assessment is not standard.
- This study investigates the prevalence of preoperative renal function testing and its impact on outcomes in major pediatric urological surgeries.
- There is a potential for underdiagnosis of renal dysfunction in pediatric urology patients post-surgery.
Purpose of the Study:
- To assess the rates of preoperative renal function testing in pediatric urological surgery.
- To identify the prevalence of abnormal renal function in this population.
- To determine the association between preoperative renal function and postoperative complications.
Main Methods:
- Data from the 2012-2019 National Surgical Quality Improvement Program-Pediatric database were analyzed.
- Inclusion criteria: pediatric patients undergoing inpatient major urological surgery.
- Abnormal renal function defined by creatinine (Cr) levels (<2 years) or estimated glomerular filtration rate (eGFR) (≥2 years) using the bedside Schwartz equation.
Main Results:
- Out of 17,315 patients, only 21.9% had documented Cr values.
- Abnormal renal function was detected in 7.3% of infants, 6.3% of children, and 15.0% of adolescents.
- Patients with abnormal preoperative renal function had significantly higher rates of readmission, reoperation, infection, transfusion, renal insufficiency, and urinary tract infection (p < 0.001).
Conclusions:
- Documented preoperative renal function tests were available for only 21.9% of pediatric patients undergoing major urological surgery.
- Abnormal preoperative renal function is linked to increased postoperative complication rates, including renal insufficiency and acute renal failure.
- Implementing standardized risk assessment tools could benefit patients by identifying those at higher risk for complications, warranting further investigation.
Background:
Renal protection is a frequent indication for urological surgery in pediatric patients; however, preoperative assessment is not routinely performed. We assessed the rates of preoperative renal function testing and stratified outcomes after major pediatric urological surgery. Pediatric urology patients, specifically high-risk patients undergoing genitourinary surgeries, are likely to have an underdiagnosis of renal dysfunction after surgery.
Materials And Methods:
Cases were identified from the 2012 to 2019 National Surgical Quality Improvement Program-Pediatric database. Patients who underwent major urological surgery on an inpatient basis were included in this study. Abnormal renal function was defined as a creatinine (Cr) level of ≥0.5 mg/dL (younger than 2 years) and a glomerular filtration rate of <90 mL/min (2 years or older). Glomerular filtration rate was calculated using the bedside Schwartz equation (2 years or older): estimated glomerular filtration rate = 0.413 × (height/Cr).
Results:
A total of 17,315 patients were included, of whom 3792 (21.9%) had documented Cr values. Based on the defined criteria, abnormal renal function was found in 7.3% of infants (younger than 2 years), 6.3% of children (2-9 years), and 15.0% of adolescents (10-18 years). Patients with abnormal preoperative renal function values were significantly (p < 0.001) more likely to experience readmission (10.2% vs. 5.8%), reoperation (3.7% vs. 1.6%), surgical organ/space infection (0.9% vs. 0.4%), transfusion (1.5% vs. 0.6%), renal insufficiency (1.6% vs. 0.4%), or urinary tract infection (5.1% vs. 3.6%).
Conclusions:
In this pediatric population, 21.9% of the patients had documented preoperative Cr values before major urological surgery. Patients with documented abnormal preoperative renal function tests experienced higher complication rates. These patients have higher rates of progressive renal insufficiency and acute renal failure than those with normal renal function. The introduction of a standardized and unbiased risk assessment tool has the potential to offer patients benefits by pinpointing individuals with a heightened risk of complications. Further investigation is necessary to enhance the precise categorization of at-risk patients.
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