Shibani Padhy1, Prachi Kar2, Gopinath Ramachandran3. 1. Assistant Professor, Department of Anaesthesiology, Nizams Institute of Mecial Sciences, Hyderabad, Telengana, India. 2. Assistant Professor, Department of Anaesthesiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India. 3. Professor, Department of Anaesthesiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India.
Abstract
INTRODUCTON: Little is known about the prognostic utility of preoperative estimated GFR (eGFR) on perioperative Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) in apparently lower risk patients undergoing moderate risk surgeries like thoracotomy. AIM: The current study sought to identify a clinically relevant cut-off value of eGFR for identifying thoracotomy patients at higher risk for MACCE. MATERIALS AND METHODS: Between July 2012 and July 2016, 436 consecutive patients were retrospectively studied after elective thoracotomy in a single institution. Patients were classified into six groups according to the calculated Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPI) eGFR (ml min -11.73 m -2): Stage 1, eGFR >90; Stage 2, eGFR=60-89.9; Stage 3a, eGFR=45-59.9; Stage 3b, eGFR=30-44.9; Stage 4, eGFR=15-29.9; Stage 5, eGFR <15. All the eGFR groups were analysed for perioperative MACCE, length of hospital stay, and mortality. RESULTS: The incidence of perioperative MACCE in our study was 4.24%. The mean eGFR in our study as calculated by the CKD-EPI equation was 83 ml min-11.73 m-2. With the exception of nonfatal cardiac arrest which was not seen in any patient, the incidence of all MACCE increased with progressively worsening preoperative eGFR.It was seen by logistic regression analysis that the occurrence of any perioperative MACCE increased significantly with worsening eGFR (p<0.001). The increase in MACCE was particularly marked from Stage 3b onwards to the later stages (OR 1.9 in 3a vs. 3.6 in 3b). The two mortalities observed in the study were in Stages 4 and 5 with no deaths seen in the better eGFR subgroups. There was also an increased length of hospital stay with declining eGFR. CONCLUSION: Preoperative eGFR is a predictor of perioperative MACCE in homogenous moderate risk elective surgical population like thoracic surgeries. There is an inverse relationship between eGFR and MACCE, particularly manifested at eGFR values <45 ml/min/1.73. Routine use of preoperative eGFR for cardiovascular and cerebrovascular risk assessment in patients undergoing moderate risk surgeries like thoracotomy would be beneficial.
INTRODUCTON: Little is known about the prognostic utility of preoperative estimated GFR (eGFR) on perioperative Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) in apparently lower risk patients undergoing moderate risk surgeries like thoracotomy. AIM: The current study sought to identify a clinically relevant cut-off value of eGFR for identifying thoracotomy patients at higher risk for MACCE. MATERIALS AND METHODS: Between July 2012 and July 2016, 436 consecutive patients were retrospectively studied after elective thoracotomy in a single institution. Patients were classified into six groups according to the calculated Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPI) eGFR (ml min -11.73 m -2): Stage 1, eGFR >90; Stage 2, eGFR=60-89.9; Stage 3a, eGFR=45-59.9; Stage 3b, eGFR=30-44.9; Stage 4, eGFR=15-29.9; Stage 5, eGFR <15. All the eGFR groups were analysed for perioperative MACCE, length of hospital stay, and mortality. RESULTS: The incidence of perioperative MACCE in our study was 4.24%. The mean eGFR in our study as calculated by the CKD-EPI equation was 83 ml min-11.73 m-2. With the exception of nonfatal cardiac arrest which was not seen in any patient, the incidence of all MACCE increased with progressively worsening preoperative eGFR.It was seen by logistic regression analysis that the occurrence of any perioperative MACCE increased significantly with worsening eGFR (p<0.001). The increase in MACCE was particularly marked from Stage 3b onwards to the later stages (OR 1.9 in 3a vs. 3.6 in 3b). The two mortalities observed in the study were in Stages 4 and 5 with no deaths seen in the better eGFR subgroups. There was also an increased length of hospital stay with declining eGFR. CONCLUSION: Preoperative eGFR is a predictor of perioperative MACCE in homogenous moderate risk elective surgical population like thoracic surgeries. There is an inverse relationship between eGFR and MACCE, particularly manifested at eGFR values <45 ml/min/1.73. Routine use of preoperative eGFR for cardiovascular and cerebrovascular risk assessment in patients undergoing moderate risk surgeries like thoracotomy would be beneficial.
Authors: John F Mooney; Isuru Ranasinghe; Clara K Chow; Vlado Perkovic; Federica Barzi; Sophia Zoungas; Martin J Holzmann; Gijs M Welten; Fausto Biancari; Vin-Cent Wu; Timothy C Tan; Alan Cass; Graham S Hillis Journal: Anesthesiology Date: 2013-04 Impact factor: 7.892
Authors: Kunihiro Matsushita; Marije van der Velde; Brad C Astor; Mark Woodward; Andrew S Levey; Paul E de Jong; Josef Coresh; Ron T Gansevoort Journal: Lancet Date: 2010-05-17 Impact factor: 79.321
Authors: A Mases; S Sabaté; N Guilera; M Sadurní; R Arroyo; M Fau; A Rojo; J Castillo; J Bover; P Sierra; J Canet Journal: Br J Anaesth Date: 2014-06-13 Impact factor: 9.166
Authors: Lesley A Stevens; Suying Li; Manjula Kurella Tamura; Shu-Cheng Chen; Joseph A Vassalotti; Keith C Norris; Adam T Whaley-Connell; George L Bakris; Peter A McCullough Journal: Am J Kidney Dis Date: 2011-03 Impact factor: 8.860
Authors: Gareth L Ackland; Noeleen Moran; Steven Cone; Michael P W Grocott; Michael G Mythen Journal: Anesth Analg Date: 2010-08-31 Impact factor: 5.108
Authors: Marije van der Velde; Kunihiro Matsushita; Josef Coresh; Brad C Astor; Mark Woodward; Andrew Levey; Paul de Jong; Ron T Gansevoort; Marije van der Velde; Kunihiro Matsushita; Josef Coresh; Brad C Astor; Mark Woodward; Andrew S Levey; Paul E de Jong; Ron T Gansevoort; Andrew Levey; Meguid El-Nahas; Kai-Uwe Eckardt; Bertram L Kasiske; Toshiharu Ninomiya; John Chalmers; Stephen Macmahon; Marcello Tonelli; Brenda Hemmelgarn; Frank Sacks; Gary Curhan; Allan J Collins; Suying Li; Shu-Cheng Chen; K P Hawaii Cohort; Brian J Lee; Areef Ishani; James Neaton; Ken Svendsen; Johannes F E Mann; Salim Yusuf; Koon K Teo; Peggy Gao; Robert G Nelson; William C Knowler; Henk J Bilo; Hanneke Joosten; Nanno Kleefstra; K H Groenier; Priscilla Auguste; Kasper Veldhuis; Yaping Wang; Laura Camarata; Beverly Thomas; Tom Manley Journal: Kidney Int Date: 2011-02-09 Impact factor: 10.612
Authors: Josef Coresh; Elizabeth Selvin; Lesley A Stevens; Jane Manzi; John W Kusek; Paul Eggers; Frederick Van Lente; Andrew S Levey Journal: JAMA Date: 2007-11-07 Impact factor: 56.272
Authors: Kunihiro Matsushita; Bakhtawar K Mahmoodi; Mark Woodward; Jonathan R Emberson; Tazeen H Jafar; Sun Ha Jee; Kevan R Polkinghorne; Anoop Shankar; David H Smith; Marcello Tonelli; David G Warnock; Chi-Pang Wen; Josef Coresh; Ron T Gansevoort; Brenda R Hemmelgarn; Andrew S Levey Journal: JAMA Date: 2012-05-09 Impact factor: 56.272