Development and Validation of a Risk Calculator for Renal Complications after Colorectal Surgery Using the National Surgical Quality Improvement Program Participant Use Files

Ramonell, Kimberly M.; Fang, Shuyang; Perez, Sebastian D.; Srinivasan, Jahnavi K.; Sullivan, Patrick S.; Galloway, John R.; Staley, Charles A.; Lee, Edward; Sharma, Jyotirmay; Sweeney, John F.; Shaffer, Virginia

doi:10.1177/000313481608201234

Cited by 6 publications

(14 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In our study, independent risk factors for renal replacement were a low number of platelets before surgery, age, and especially ASA score with an increase of 15 times per ASA point (for example, ASA 3 results in a 30 times increased risk!). This correlates to the study from Ramonell, who could also identify ASA score as well as hypoalbuminemia and age as risk factors for renal failure [ 33 ]. Because age and ASA score cannot be improved, particular attention should be paid to renal function during and after surgery with thoughtful fluid therapy, an early substitution of albumin, and the start of terlipressin treatment.…”

Section: Discussionsupporting

confidence: 74%

Risk Factors for Postoperative Morbidity and Mortality after Small Bowel Surgery in Patients with Cirrhotic Liver Disease—A Retrospective Analysis of 76 Cases in a Tertiary Center

Wetterkamp

Beekum

Willis

et al. 2020

Biology

View full text Add to dashboard Cite

(1) Purpose: As it is known, patients with liver cirrhosis (LC) undergoing colon surgery or hernia surgery have high perioperative morbidity and mortality. However, data about patients with LC undergoing small bowel surgery is lacking. This study aimed to analyze the morbidity and mortality of patients with LC after small bowel surgery in order to determine predictive risk factors for a poor outcome. (2) Methods: A retrospective analysis was performed of all patients undergoing small bowel surgery between January 2002 and July 2018 and identified 76 patients with LC. Postoperative complications were analyzed using the classification of Dindo/Clavien (D/C) and further subdivided (hemorrhage, pulmonary complication, wound healing disturbances, renal failure). A total of 38 possible predictive factors underwent univariate and multivariate analyses for different postoperative complications and in-hospital mortality. (3) Results: Postoperative complications [D/C grade ≥ II] occurred in 90.8% of patients and severe complications (D/C grade ≥ IIIB) in 53.9% of patients. Nine patients (11.8%) died during the postoperative course. Predictive factors for overall complications were “additional surgery” (OR 5.3) and “bowel anastomosis” (OR 5.6). For postoperative mortality, we identified the model of end-stage liver disease (MELD) score (OR 1.3) and portal hypertension (OR 5.8) as predictors. The most common complication was hemorrhage, followed by pulmonary complications, hydropic decompensation, renal failure, and wound healing disturbances. The most common risk factors for those complications were portal hypertension (PH), poor liver function, emergency or additional surgery, ascites, and high ASA score. (4) Conclusions: LC has a devastating influence on patients’ outcomes after small bowel resection. PH, poor liver function, high ASA score, and additional or emergency surgery as well as ascites were significant risk factors for worse outcomes. Therefore, PH should be treated before surgery whenever possible. Expansion of the operation should be avoided whenever possible and in case of at least moderate preoperative ascites, the creation of an anastomotic ostomy should be evaluated to prevent leakages.

show abstract

Section: Discussionsupporting

confidence: 74%

Risk Factors for Postoperative Morbidity and Mortality after Small Bowel Surgery in Patients with Cirrhotic Liver Disease—A Retrospective Analysis of 76 Cases in a Tertiary Center

Wetterkamp

Beekum

Willis

et al. 2020

Biology

View full text Add to dashboard Cite

show abstract

“…The unadjusted cohort consisted of 68 studies which included 232,586,252 patients (130,605,382 women and 101,970,870 men (Figs. 3 and 4 ) [ 29 , 31 – 34 , 36 , 38 , 42 , 43 , 45 , 47 , 57 – 112 ]. Studies could be divided into 7 distinct categories.…”

Section: Resultsmentioning

confidence: 99%

Female sex reduces the risk of hospital-associated acute kidney injury: a meta-analysis

Neugarten

Golestaneh

2018

BMC Nephrol

View full text Add to dashboard Cite

BackgroundFemale sex has been included as a risk factor in models developed to predict the development of AKI. In addition, the commentary to the Kidney Disease Improving Global Outcomes Clinical Practice Guideline for AKI concludes that female sex is a risk factor for hospital-acquired AKI. In contrast, a protective effect of female sex has been demonstrated in animal models of ischemic AKI.MethodsTo further explore this issue, we performed a meta-analysis of AKI studies published between January, 1978 and April, 2018 and identified 83 studies reporting sex-stratified data on the incidence of hospital-associated AKI among nearly 240,000,000 patients.ResultsTwenty-eight studies (6,758,124 patients) utilized multivariate analysis to assess risk factors for hospital-associated AKI and provided sex-stratified ORs. Meta-analysis of this cohort showed that the risk of developing hospital-associated AKI was significantly greater in men than in women (OR 1.23 (1.11,1.36). Since AKI is not a single disease but instead represents a heterogeneous group of disorders characterized by an acute reduction in renal function, we performed subgroup meta-analyses. The association of male sex with AKI was strongest among studies of patients who underwent non-cardiac surgery. Male sex was also associated with AKI in studies which included unselected hospitalized patients and in studies of critically ill patients who received care in an intensive care unit. In contrast, cardiac surgery-associated AKI and radiocontrast-induced AKI showed no sexual dimorphism.ConclusionsOur meta-analysis contradicts the established belief that female sex confers a greater risk of AKI and instead suggests a protective role.

show abstract

“…Preexisting renal insufficiency predisposes to a large number of postoperative complications. These include wound healing disorders, pneumonia, urinary tract infections, acute renal failure, cardiac events and septic courses with multiorgan failure [ 8 ], [ 9 ]. Analogous correlations were found analyzing complications in the cohort of patients in this study.…”

Section: Discussionmentioning

confidence: 99%

“…There are only a comparatively small number of studies that examine the significance of high blood pressure for the early postoperative course after colorectal surgery. Nonsurgical complications such as renal, cardiac and pulmonary events are described after operations with curative intent [ 8 ], [ 14 ]. The present study in palliative patients also showed a hypertension-induced multivariate significant increase in postoperative medical morbidity to 1.4 times.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors of early outcome after palliative surgery for colorectal carcinoma

Konopke¹,

Schubert²,

Stöltzing³

et al. 2020

Innovative Surgical Sciences

View full text Add to dashboard Cite

ObjectivesA significant number of patients with colorectal cancer are presented with various conditions requiring surgery in an oncologically palliative setting. We performed this study to identify risk factors for early outcome after surgery to facilitate the decision-making process for therapy in a palliative disease.MethodsWe performed a retrospective chart review of 142 patients who underwent palliative surgery due to locally advanced, complicated, or advanced metastatic colorectal carcinoma between January 2010 and April 2018 at the “Elbland” Medical Center Riesa. We performed a logistic regression analysis of 43 factors to identify independent predictors for complications and mortality.ResultsSurgery included resections with primary anastomosis (n=31; 21.8%) or discontinuous resections with colostomy (n=38; 26.8%), internal bypasses (n=27; 19.0%) and stoma formation only (n=46; 32.4%). The median length of hospitalization was 12 days (2–53 days), in-hospital morbidity was 50.0% and the mortality rate was 18.3%. Independent risk factors of in-hospital morbidity were age (HR: 1.5, p=0.046) and various comorbidities of the patients [obesity (HR: 1.8, p=0.036), renal failure (HR: 1.6, p=0.040), diabetes (HR: 1.6, p=0.032), alcohol abuse (HR: 1.3, p=0.023)] as well as lung metastases (HR: 1.6, p=0.041). Arteriosclerosis (HR: 1.4; p=0.045) and arterial hypertension (HR: 1.4, p=0.042) were independent risk factors for medical complications in multivariate analysis. None of the analyzed factors predicted the surgical morbidity after the palliative procedures. Emergency surgery (HR: 10.2, p=0.019), intestinal obstruction (HR: 9.2, p=0.006) and ascites (HR: 5.0, p=0.034) were multivariate significant parameters of in-hospital mortality.ConclusionsPalliatively treated patients with colorectal cancer undergoing surgery show high rates of morbidity and mortality after surgery. In this retrospective chart review, independent risk factors for morbidity and in-hospital mortality were identified that are similar to patients in curative care. An adequate selection of patients before palliative operation should lead to a better outcome after surgery. Especially in patients with intestinal obstruction and ascites scheduled for emergency surgery, every effort should be made to convey these patients to elective surgery by interventional therapy, such as a stent or minimally invasive stoma formation.

show abstract

Development and Validation of a Risk Calculator for Renal Complications after Colorectal Surgery Using the National Surgical Quality Improvement Program Participant Use Files

Cited by 6 publications

References 13 publications

Risk Factors for Postoperative Morbidity and Mortality after Small Bowel Surgery in Patients with Cirrhotic Liver Disease—A Retrospective Analysis of 76 Cases in a Tertiary Center

Risk Factors for Postoperative Morbidity and Mortality after Small Bowel Surgery in Patients with Cirrhotic Liver Disease—A Retrospective Analysis of 76 Cases in a Tertiary Center

Female sex reduces the risk of hospital-associated acute kidney injury: a meta-analysis

Predictive factors of early outcome after palliative surgery for colorectal carcinoma

Contact Info

Product

Resources

About