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Association of pre-operative estimated GFR on post-operative pulmonary complications in laparoscopic surgeries.

Association of pre-operative estimated GFR on post-operative pulmonary complications in laparoscopic surgeries.
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Shimomura A, Obi Y, Fazl Alizadeh R, Li S, Nguyen NT, Stamos MJ, Kalantar-Zadeh K, Ichii H,


Shimomura A, Obi Y, Fazl Alizadeh R, Li S, Nguyen NT, Stamos MJ, Kalantar-Zadeh K, Ichii H, (click to view)

Shimomura A, Obi Y, Fazl Alizadeh R, Li S, Nguyen NT, Stamos MJ, Kalantar-Zadeh K, Ichii H,

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Scientific reports 2017 07 267(1) 6504 doi 10.1038/s41598-017-06842-4
Abstract

Despite a large body of evidence showing the pandemic of chronic kidney disease, the impact of pre-operative kidney function on the risk of post-operative pulmonary complications (PPCs) is not well known. We used multivariable logistic regression analyses with 3-level hierarchical adjustments to identify the association of pre-operative estimated glomerular filtration rate (eGFR) with PPCs in laparoscopic surgeries. Among 452,213 patients between 2005 and 2013 in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database, a total of 3,727 patients (0.9%) experienced PPCs. We found a gradient association between lower eGFR and higher likelihood of PPCs in the unadjusted model. In the case-mix adjusted model, a reverse-J-shaped association was observed; a small albeit significant association with the highest eGFR category emerged. Further adjustment slightly attenuated these associations, but the PPCs risk in the eGFR groups of <30, 30-60, and ≥120 mL/min/1.73 m(2) remained significant: odds ratios (95% confidence intervals) of 1.82 (1.54-2.16), 1.38 (1.24-1.54), and 1.28 (1.07-1.53), respectively (reference: 90-120 mL/min/1.73 m(2)). Our findings propose a need for careful pre-operative evaluation of cardiovascular and pulmonary functions and post-operative fluid management among patients with not only lower but also very high eGFR.

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