دورية أكاديمية
Low serum creatinine levels are associated with major post-operative complications in patients undergoing surgery with gynecologic oncologists.
العنوان: | Low serum creatinine levels are associated with major post-operative complications in patients undergoing surgery with gynecologic oncologists. |
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المؤلفون: | Wang CC; Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA connorcwang.pub@gmail.com., Bharadwa S; Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Foley OW; Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Domenech I; Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Vega B; Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Towner M; Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Barber EL; Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. |
المصدر: | International journal of gynecological cancer : official journal of the International Gynecological Cancer Society [Int J Gynecol Cancer] 2024 Jul 01; Vol. 34 (7), pp. 1060-1069. Date of Electronic Publication: 2024 Jul 01. |
نوع المنشور: | Journal Article |
اللغة: | English |
بيانات الدورية: | Publisher: BMJ Country of Publication: England NLM ID: 9111626 Publication Model: Electronic Cited Medium: Internet ISSN: 1525-1438 (Electronic) Linking ISSN: 1048891X NLM ISO Abbreviation: Int J Gynecol Cancer Subsets: MEDLINE |
أسماء مطبوعة: | Publication: 2019- : [London] : BMJ Original Publication: Cambridge, MA, USA : Blackwell Scientific Publications, c1991- |
مواضيع طبية MeSH: | Postoperative Complications*/epidemiology , Postoperative Complications*/blood , Postoperative Complications*/etiology , Creatinine*/blood , Genital Neoplasms, Female*/surgery , Genital Neoplasms, Female*/blood, Humans ; Female ; Retrospective Studies ; Middle Aged ; Aged ; Gynecologic Surgical Procedures/adverse effects ; Adult ; Cohort Studies |
مستخلص: | Objective: Serum creatinine is a byproduct of muscle metabolism, and low creatinine is postulated to be associated with diminished muscle mass. This study examined the association between low pre-operative serum creatinine and post-operative outcomes. Methods: This retrospective cohort study utilized the 2014-2021 National Surgical Quality Improvement Program to identify patients undergoing surgery with gynecologic oncologists. Patients with missing pre-operative creatinine, end-stage renal disease, sepsis, septic shock, dialysis, or pregnancy were excluded. Pre-operative creatinine was categorized into markedly low (≤0.44 mg/dL), mildly low (0.45-0.64 mg/dL), normal (0.65-0.84 mg/dL), and four categories of elevated levels (0.85-1.04, 1.05-1.24, 1.25-1.44, and ≥1.45 mg/dL). Outcomes included major (≥Grade 3) 30-day complications, categorized into any complications, wound, cardiovascular and pulmonary, renal, infectious, and thromboembolic complications. Also examined were 30-day readmissions, reoperations, and mortality. Logistic regressions assessed the association between creatinine and complications, with stratification by albumin and sensitivity analysis with propensity score matching. Results: Among 84 786 patients, 0.8% had markedly low, 19.6% mildly low, and 50.2% normal creatinine; the remainder had elevated creatinine. As creatinine decreased, the risks of major complications increased in a dose-dependent manner on univariable and multivariable analyses. A total of 9.6% (n=63) markedly low patients experienced major complications, second to creatinine ≥1.45 mg/dL (9.9%, n=141). On multivariable models, both markedly and mildly low creatinine were associated with higher odds of major complications (OR 1.715, 95% CI 1.299 to 2.264 and OR 1.093, 95% CI 1.001 to 1.193) and infections (OR 1.575, 95% CI 1.118 to 2.218 and OR 1.165, 95% CI 1.048 to 1.296) versus normal. Markedly low creatinine had similar ORs to creatinine ≥1.45 mg/dL and was further associated with higher odds of cardiovascular and pulmonary complications (OR 2.301, 95% CI 1.300 to 4.071), readmissions (OR 1.403, 95% CI 1.045 to 1.884), and mortality (OR 2.718, 95% CI 1.050 to 7.031). After albumin stratification, associations persisted for markedly low creatinine. Propensity-weighted analyses demonstrated congruent findings. Conclusions: Low creatinine levels are associated with major post-operative complications in gynecologic oncology in a dose-dependent manner. Low creatinine can offer useful information for pre-operative risk stratification, surgical counseling, and peri-operative management. Competing Interests: Competing interests: ELB received career development funds from the Gynecologic Oncology Group (GOG) Foundation and funds to the institution from the National Institute on Aging (NIA) (R03 AG074031-01). (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.) |
فهرسة مساهمة: | Keywords: Gynecologic Surgical Procedures; Postoperative complications; Surgery; Surgical Procedures, Operative |
المشرفين على المادة: | AYI8EX34EU (Creatinine) |
تواريخ الأحداث: | Date Created: 20240416 Date Completed: 20240701 Latest Revision: 20240701 |
رمز التحديث: | 20240702 |
DOI: | 10.1136/ijgc-2024-005308 |
PMID: | 38627036 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1525-1438 |
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DOI: | 10.1136/ijgc-2024-005308 |