EFFECT OF RENAL-INSUFFICIENCY ON OUTCOME FOLLOWING INFRARENAL AORTIC-SURGERY

BACKGROUND: This study reviewed the effect of preoperative renal insuf ficiency on outcome following elective infrarenal aortic surgery. METH ODS: The charts of 210 consecutive patients undergoing aortic surgery (occlusive disease, 15%; aneurysmal disease, 78%; or combined disease, 7%) from 1990 to 1995 were categorized into three groups based on pre operative creatinine ([Cr] group 1 Cr <1.5, n = 171; group 2 Cr 1.5 to 1.7, n = 22; and group 3 Cr greater than or equal to 1.8, n = 17) and calculated creatinine clearance ([CrCl] CrCl >45 mL/min, n = 162 vers us CrCl <45 mL/min, n = 48). Patients with renal artery stenosis or th ose who required suprarenal cross clamping or emergency procedures wer e excluded. Differences in postoperative intensive care unit (ICU) sta y, ventilator days, dialysis dependence, morbidity, and, mortality wer e compared, RESULTS: Patients in groups 2 and 3 had an increased incid ence of postoperative dialysis dependence (group 2 9%, group 3 8%) whe n compared with patients in group 1 (group 1: 0%, P < 0.05). Patients in the CrCl >45 group had a lower mortality rate when compared with pa tients with a CrCl >45 (CrCl >45 0.6% versus CrCl <45 8%, P <0.05) a l ower incidence of dialysis (0% versus 7%, P (0.05), and a lower incide nce of postoperative serum creatinine elevation from baseline (CrCl >4 5 8% versus CrCl <45 18%, P <0.05). There was no significant differenc e in morbidity, ICU stay, or ventilator days between the groups. Upon regression analysis, preoperative CrCl but not Cr was predictive of po stoperative mortality (P <0.05). Serum Cr was more predictive than CrC l of impaired renal function postoperatively. CONCLUSIONS: Preoperativ e CrCl is more accurate than Cr as a predictor of postoperative mortal ity. Patients with preoperative CrCl <45 mL/minute who undergo electiv e aortic surgery have a significant increase in postoperative cardiac- related mortality and dialysis. (C) 1997 by Excerpta Medica, Inc.