Are postoperative complications more common following colon and rectal surgery in patients with chronic kidney disease?
Article first published online: 20 DEC 2012
© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
Volume 15, Issue 1, pages 85–90, January 2013
How to Cite
Canedo, J., Ricciardi, K., DaSilva, G., Rosen, L., Weiss, E. G. and Wexner, S. D. (2013), Are postoperative complications more common following colon and rectal surgery in patients with chronic kidney disease?. Colorectal Disease, 15: 85–90. doi: 10.1111/j.1463-1318.2012.03099.x
- Issue published online: 20 DEC 2012
- Article first published online: 20 DEC 2012
- Accepted manuscript online: 25 MAY 2012 09:57AM EST
- Received 23 December 2011; accepted 27 March 2012; Accepted Article online 25 May 2012
- Colorectal surgery;
- chronic kidney disease;
- glomerular filtration rate;
- Crockcroft–Gault formula
Aim According to National Kidney Foundation guidelines, early stages of chronic kidney disease (CKD) can be detected through the estimated glomerular filtration rate (eGFR). We assessed complications following colorectal surgery (CRS) in patients with CKD Stages 3 and 4, as defined by the eGFR.
Method Patients with CKD were identified within our database. Patients with an eGFR of 15–59 ml/min (CKD Stages 3 and 4) formed the CKD group and were compared with American Society of Anesthesiology (ASA) score-matched controls with an eGFR of ≥ 60 ml/min. Assessments included demographics, comorbidity, ASA score, operative details and 30-day postoperative outcome.
Results Seventy patients in the CKD group were matched with 70 controls. ASA scores and length of stay did not differ significantly between the groups. CKD patients were older (mean age 76.5 years vs 71.1 years; P < 0.001) and had a lower mean body mass index (24.3 vs 28.2; P < 0.001) compared with controls. Compared with the CKD group, the mean operation time was longer in the control group (181.5 min vs 151.6 min; P = 0.02) and the estimated blood loss was greater (232 ml vs 165 ml; P = 0.004). Postoperative infection was more common in the CKD group (60%vs 40%; P = 0.01). There were no significant differences in reoperation rates, 30-day readmissions or the incidence of acute renal failure (ARF).
Conclusion Patients with CKD Stages 3 and 4 had a higher incidence of postoperative infections than matched controls after colorectal surgery. ARF developed in 18.6% of patients. Preoperative optimization should include adequate hydration and assessment of potentially nephrotoxic substances for bowel preparation, preoperative antibiotics and pain control.