Association of pre-operative estimated GFR on post-operative pulmonary complications in laparoscopic surgeries

作者：Shimomura Akihiro; Obi Yoshitsugu^*; Alizadeh Reza Fazl; Li Shiri; Nguyen Ninh T; Stamos Michael J; Kalantar Zadeh Kamyar; Ichii Hirohito^*

来源：Scientific Reports, 2017, 7(1): 6504.

DOI：10.1038/s41598-017-06842-4

Despite a large body of evidence showing the pandemic of chronic kidney disease, the impact of preoperative kidney function on the risk of post-operative pulmonary complications (PPCs) is not well known. We used multivariable logistic regression analyses with 3-level hierarchical adjustments to identify the association of pre-operative estimated glomerular filtration rate (eGFR) with PPCs in laparoscopic surgeries. Among 452,213 patients between 2005 and 2013 in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database, a total of 3,727 patients (0.9%) experienced PPCs. We found a gradient association between lower eGFR and higher likelihood of PPCs in the unadjusted model. In the case-mix adjusted model, a reverse-J-shaped association was observed; a small albeit significant association with the highest eGFR category emerged. Further adjustment slightly attenuated these associations, but the PPCs risk in the eGFR groups of < 30, 30-60, and >= 120 mL/min/1.73 m(2) remained significant: odds ratios (95% confidence intervals) of 1.82 (1.54-2.16), 1.38 (1.24-1.54), and 1.28 (1.07-1.53), respectively (reference: 90-120 mL/min/1.73 m(2)). Our findings propose a need for careful pre-operative evaluation of cardiovascular and pulmonary functions and post-operative fluid management among patients with not only lower but also very high eGFR.

• 出版日期2017-7-26