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The Relationship Between Age and Chronic Kidney Disease in Patients Undergoing Pancreatic Resection

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Severe chronic kidney disease (CKD) predicts adverse outcomes in patients undergoing pancreatectomy, but the impact of milder CKD is unknown. Additionally, some authors have suggested that, due to physiologic changes of aging, CKD is over-diagnosed in patients above age 65.

Methods

Patients undergoing pancreatectomy for malignancy from 2005 to 2014 were identified from the National Surgical Quality Improvement Program. Primary outcomes were all-cause mortality and major complication, defined as myocardial infarction, cardiac arrest, stroke, venous thromboembolism, respiratory failure, deep surgical site infection, pneumonia, acute kidney injury, coma > 24 h, or re-operation occurring within 30 days of surgery.

Results

The mean age of 16,173 participants was 66 (range 18–90). Median preoperative creatinine was 0.80 mg/dL (0.10–11.0), and median preoperative eGFR was 86.36 mL/min/1.73m2 (2.98–182.2). Mortality and major complication occurred in 3 and 23% of patients, respectively. In adjusted analyses, CKD stages 2 (adjusted odds ratio (aOR) 1.24, 95% confidence interval (CI) 1.10–1.40), 3a (aOR 1.50, 95% CI 1.24–1.82), 3b (aOR 1.56, 95% CI 1.19–2.06), and 4 (aOR 2.17, 95% CI 1.25–3.76) were associated with increased major complication, and CKD stage 4 was associated with increased mortality (aOR 2.68, 95% CI 1.10–6.56). Age did not influence the relationship between CKD and either outcome.

Conclusion

CKD of any stage was associated with an increased risk of postoperative major complication, and severe CKD was associated with increased mortality among patients undergoing pancreatectomy for malignancy. These associations were not diminished in elderly patients. Our findings could inform preoperative counseling and decision-making.

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Acknowledgements

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Authors and Affiliations

  1. Department of Medicine, Division of General Internal Medicine – Academic, University of Nebraska Medical Center, Omaha, NE, USA

    Derrick Antoniak, Chad Vokoun & Jason Shiffermiller

  2. Department of Medicine, Veterans Affairs Nebraska Western Iowa Health Care System, Omaha, NE, USA

    Derrick Antoniak

  3. Department of Surgery, Division of Surgical Oncology, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, 68198, USA

    Chandrakanth Are

  4. Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA

    Kaeli Samson & Lynette Smith

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  1. Derrick Antoniak
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Correspondence to Chandrakanth Are.

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Antoniak, D., Are, C., Vokoun, C. et al. The Relationship Between Age and Chronic Kidney Disease in Patients Undergoing Pancreatic Resection. J Gastrointest Surg 22, 1376–1384 (2018). https://doi.org/10.1007/s11605-018-3743-8

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  • DOI: https://doi.org/10.1007/s11605-018-3743-8

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