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Even minor alteration of plasma creatinine after open abdominal surgery is associated with 30-day mortality: A single-centre cohort study - 19/11/21

Doi : 10.1016/j.jviscsurg.2021.10.008 
S. Soltanizadeh a, , K.K. Jensen a, A.K. Nordklint b, H.L. Jørgensen b, L.N. Jørgensen a
a Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2300 Copenhagen NV, Denmark 
b Department of Clinical Biochemistry, Hvidovre Hospital, University of Copenhagen, 2650 Hvidovre, Denmark 

Corresponding author.
En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Friday 19 November 2021
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Highlights

This study investigates data from 3,460 patients undergoing open abdominal surgery.
Minor daily postoperative p-creatinine increase is associated with elevated 30-day mortality risk.
After elective surgery, postoperative p-creatinine increase is associated with nearly a 30-fold risk of 30-day mortality.
Male patients and patients with advanced age are particularly at higher risk of 30-day mortality after postoperative increase of p-creatinine.

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Summary

Purpose

Postoperative acute kidney injury is common and associated with increased length of hospital stay, costs and mortality. The impact from postoperative subclinical changes in plasma concentration of creatinine (p-creatinine) on postoperative mortality has received less attention. In this study, the association between the postoperative change of p-creatinine and all-cause mortality was investigated.

Methods

A single-centre register-based, retrospective study was conducted including patients ≥60 years undergoing open abdominal surgery from 2000 to 2013. Postoperative p-creatinine change was analysed for association with 30-day mortality following adjustment for age, gender, surgical setting and surgical procedure.

Main findings A total of 3,460 patients were included in the study of whom 67.6% underwent emergency surgery. The 30-day mortality rate was 18.3%, and a given 10μmol/L daily postoperative increase in p-creatinine was associated with an increased mortality risk with an odds ratio (OR) of 2.67 (95% CI; 2.28-3.14, P<0.001). In patients undergoing emergency surgery, a daily 10μmol/L increase in p-creatinine increased the risk for a fatal outcome a 2.39 OR (CI 95%; 2.05-2.78), P<0.001). In patients undergoing elective surgery, a similar increase in p-creatinine increased risk of postoperative death with a 28.85 OR (CI 95%; 10.25-81.19).

Conclusion

Even a minor postoperative p-creatinine increase following open abdominal surgery below the criteria for acute kidney injury was associated with increased 30-day mortality in patients aged 60 years or above.

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Keywords : Abdominal surgery, Mortality, Creatinine, Renal insufficiency, Acute kidney injury


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© 2021  The Authors. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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