RENAL IMPAIRMENT AFTER THORACOTOMY - INCIDENCE, RISK-FACTORS, AND SIGNIFICANCE

One hundred thirty patients undergoing major thoracotomy between June 1991 and June 1992 at The Royal Brompton Hospital, London, were analyz ed; renal impairment developed in 31 patients (24%). The mortality and morbidity was significantly greater for the renal impairment group. S ix patients (19%) with renal impairment died after operation, in contr ast to 0 of the 99 patients in whom renal impairment did not develop. The average length of hospital stay for the patients with renal impair ment was 12 days compared with 8 days for the normal renal function gr oup (p << 0.001). Five factors were highly significantly associated wi th renal impairment: a past history of renal impairment or diuretic in take, undergoing pneumonectomy, postoperative infection, and blood los s (p < 0.001). The most important of these appears to be postoperative infection or blood loss, as they also were associated with death (p = 0.01). Other factors less significantly associated with renal impairm ent included a past history of hypertension, ischemic heart disease, i ntraoperative gentamicin, and epidural analgesia (p < 0.01). This stud y emphasizes that thoracotomy must be considered carefully in patients with these predisposing factors, particularly if pneumonectomy is lik ely. Care must be taken in the use of aminoglycosides and epidural ana lgesia. Maintenance of renal blood now by careful control of hemodynam ic indices appears to be the most important intervention.