Implementation of a new definition for acute kidney injury in the National Surgical Quality Improvement Project: What is the impact?

Loria, Anthony; Melucci, Alexa D.; Burchard, Paul R.; Ghaffar, Aqsa; Levatino, Elizabeth; Temple, Larissa K.; Fleming, Fergal J.

doi:10.1016/j.surg.2022.11.035

Cited by 2 publications

(1 citation statement)

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“…This is likely mediated through increased rates of dehydration and acute kidney injury associated with diverting ostomies 17,18 . Recent definition changes in the National Surgical Quality Improvement Project relating to acute kidney injury may improve our understanding of the risks and benefits of diverting ostomies in older adults 19 . These findings suggest that prioritizing minimally invasive surgery and standardizing the indications for diverting ostomies is warranted in older adults.…”

Section: Discussionmentioning

confidence: 99%

New Onset Geriatric Syndromes and One-year Outcomes Following Elective Gastrointestinal Cancer Surgery

Melucci,

Loria,

Aquina

et al. 2023

Annals of Surgery

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Objective: To assess whether older adults who develop geriatric syndromes following elective gastrointestinal surgery have poorer 1-year outcomes. Summary Background Data: Within ten years, 70% of all cancers will occur in older adults ≥65 years old. The rise in older adults requiring major surgery has brought attention to age-related complications termed geriatric syndromes. However, whether postoperative geriatric syndromes are associated with long-term outcomes is unclear. Methods: A population-based retrospective cohort study using the New York State Cancer Registry and the Statewide Planning and Research Cooperative System was performed including patients >55 years with pathologic stage I-III esophageal, gastric, pancreatic, colon, or rectal cancer who underwent elective resection between 2004-2018. Those aged 55-64 served as the reference group. The exposure of interest was a geriatric syndrome (fracture, fall, delirium, pressure ulcer, depression, malnutrition, failure to thrive, dehydration, or incontinence [urinary/fecal]) during the surgical admission. Patients with any geriatric syndrome within 1 year of surgery were excluded. Outcomes included incident geriatric syndrome, 1-year days alive and out of the hospital, and 1-year all-cause mortality. Results: 37,998 patients with a median age of 71 years without a prior geriatric syndrome were included. Of those 65 years or more, 6.4% developed a geriatric syndrome. Factors associated with an incident geriatric syndrome were age, alcohol/tobacco use, comorbidities, neoadjuvant therapy, ostomies, open surgery, and upper gastrointestinal cancers. An incident geriatric syndrome was associated with a 43% higher risk of 1-year mortality (hazard ratio, 1.43; 95% confidence interval, 1.27-1.60). For those aged 65+ discharged alive and not to hospice, a geriatric syndrome was associated with significantly fewer days alive and out of hospital (322 vs. 346 d, P<0.0001). There was an indirect relationship between the number of geriatric syndromes and 1-year mortality and days alive and out of the hospital after adjusting for surgical complications. Conclusions: Given the increase in older adults requiring major surgical intervention, and the establishment of geriatric surgery accreditation programs, these data suggest that morbidity and mortality metrics should be adjusted to accommodate the independent relationship between geriatric syndromes and long-term outcomes.

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Section: Discussionmentioning

confidence: 99%