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ABSTRACT: Aim: According to National Kidney Foundation guidelines, early stages of chronic kidney disease (CKD) can be detected through estimated glomerular filtration rate (eGFR). We assessed complications following colorectal surgery (CRS) in patients with CKD stages 3 and 4, defined by eGFR. Method: CKD patients were identified within our database. Patients with an eGFR of 15-59 mL/min (CKD stage 3 and 4) formed the CKD group and were compared with American Society of Anesthesiologists (ASA) score matched controls with eGFR ≥ 60 mL/min. Assessments included demographics, comorbidity, ASA score, operative details, and 30-day postoperative outcome. Results: 70 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 vs 71.1 years; p< 0.001) and had a lower mean BMI (24.3 vs 28.2; p < 0.001) compared with controls. Compared with the CKD group, t he 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. © 2012 Cleveland Clinic Florida Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
Colorectal Disease 05/2012; · 2.08 Impact Factor