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Serum creatinine and perioperative outcome – a matched-pairs approach using computerised anaesthesia records

Published online by Cambridge University Press:  13 April 2005

M. G. Dehne ,
A. Junger ,
B. Hartmann ,
L. Quinzio ,
R. Röhrig ,
M. Benson  and
G. Hempelmann
M. G. Dehne
Affiliation:
University Hospital Giessen, Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Giessen, Germany
A. Junger
Affiliation:
University Hospital Giessen, Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Giessen, Germany
B. Hartmann
Affiliation:
University Hospital Giessen, Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Giessen, Germany
L. Quinzio
Affiliation:
University Hospital Giessen, Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Giessen, Germany
R. Röhrig
Affiliation:
University Hospital Giessen, Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Giessen, Germany
M. Benson
Affiliation:
University Hospital Giessen, Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Giessen, Germany
G. Hempelmann
Affiliation:
University Hospital Giessen, Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Giessen, Germany
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Abstract

Summary

Background and objective: A study was designed to utilise the resources of our computerised anaesthesia record keeping system to assess the attributable effects of increased preoperative creatinine (>1.3 mg dL−1) on outcome in patients undergoing non-cardiac surgery.

Methods: This retrospective study was based on data sets of 58 458 patients recorded with a computerised anaesthesia record keeping system over a period of 4 yr at a tertiary care university hospital. Cases were defined as patients with a preoperative creatinine >1.3 mg dL−1; controls (creatinine ≤1.3 mg dL−1) were selected and automatically matched according to several parameters (ASA physical status, high risk and urgency of surgery, age and gender) in a stepwise fashion. Main outcome measures were hospital mortality and the incidence of intraoperative cardiovascular events.

Results: Three-thousand-and-twenty-eight patients (5.2%) had preoperative creatinine values >1.3 mg dL−1. Matching was successful for 54.5% of the cases, leading to 1649 cases (mean creatinine 3.3 ± 2.2 mg dL−1) and 1649 controls (1.0 ± 0.2 mg dL−1). The crude mortality rates for the cases and matched controls were 2.2% (n = 36) and 0.9% (n = 15), respectively (P = 0.003). Intraoperative cardiovascular events were found in 30.1% of the patients (n = 496) and in 28.3% of the matched controls (n = 466; P = 0.25, power = 0.46). Using logistic regression analyses a significant association between preoperative increased creatinine and hospital mortality was found (odds ratio 2.62; 95% confidence interval [1.39; 4.93]).

Conclusions: An increased preoperative serum creatinine in patients undergoing non-cardiac surgery is associated with an increased perioperative risk, but not with a higher incidence of intraoperative cardiovascular events.

Keywords

ANAESTHESIAINFORMATION SYSTEMSMEDICAL RECORD SYSTEMS, computerisedCREATININEKIDNEY FAILUREOUTCOME ASSESSMENT (HEALTHCARE)RISK ASSESSMENT, cardiovascular, morbidity, mortality
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 2 , February 2005 , pp. 89 - 95
Copyright
2005 European Society of Anaesthesiology

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