B. Kavianpour1,2, Y. Sanaiha1, A. L. Mardock1, H. Xing1, S. Yazdani1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Cardiothoracic Surgery,Los Angeles, CA, USA 2Stony Brook University School of Medicine,Department of Medicine,Stony Brook, NY, USA
Introduction:
Acute renal failure (ARF) and progression to hemodialysis (HD) have been shown to significantly impact patient morbidity and mortality in various operations. The incidence of severe perioperative renal dysfunction in high acuity patients has not been well-explored at the national level. Thus, the present study aimed to evaluate the trends of perioperative ARF and HD incidence and associated mortality amongst emergency general surgery patients (EGS).
Methods:
This was a retrospective cohort study using the National Inpatient Sample to identify all adult patients (>18 years) without a prior history of chronic kidney disease who underwent an EGS procedure from 2008-2015. EGS was defined as small and large bowel resection, cholecystectomy, appendectomy, lysis of adhesions, and surgical management of ulcer disease. The study cohort was stratified into three groups: without ARF, ARF, and ARF requiring HD. A multivariable logistic regression model was developed to predict the odds of mortality and composite complications with the occurrence of perioperative ARF and/or HD. Non-parametric trend analyses of incidence and associated mortality were performed on ARF and HD patient populations.
Results:
Of an estimated 6,781,918 patients who underwent EGS during the study period, 501,678 (7.4%) patients developed ARF and 30,334 (0.4%) patients required HD. Compared to patients without ARF, ARF and HD patients were significantly older (ARF: 67.6y vs 51.2y, P<0.0001; HD: 63.2y vs 51.2y, P<0.0001) and had higher Elixhauser comorbidity scores (ARF: 3.3 vs 1.7, P<0.0001; HD: 3.4 vs 1.7, P<0.0001). Over the eight-year study, the incidence of ARF (5.4 to 9.8%, P<0.0001) significantly increased while the incidence of HD remained unchanged at 0.4% (P=0.07) (Figure 1). The in-hospital mortality rates for ARF (20.8% to 14.0%, P<0.0001) and HD (44.7% to 40.6%, P=0.0181) significantly decreased from 2008 to 2015 (Figure 1). The occurrence of ARF increased the odds of complications by 162% (OR=2.62, P<0.0001) and mortality by 120% (OR=2.20, P<0.0001) while HD increased the odds of complications by 925% (OR=10.25, P<0.0001) and mortality by 287% (OR=3.87, P<0.0001).
Conclusion:
In this national study, we found that the incidence of perioperative ARF significantly increased for the EGS population without a concomitant increase in HD. Both ARF and HD were associated with significantly higher odds of morbidity and mortality. An ongoing investigation of novel methods of perioperative ARF prevention, early detection, and intervention is warranted to improve the value of care for EGS patients.
