Location
Philadelphia, PA
Start Date
1-5-2024 1:00 PM
End Date
1-5-2024 4:00 PM
Description
Abstract
The impact of renal insufficiency on mortality and healing potential in patients undergoing limb amputation is well-known. Previous literature has pointed towards renal function and dialysis dependency as the largest contributory factors towards postoperative complications. This study reviews renal function as an independent risk factor for post-amputation complications and examines the relationship between the degree of renal dysfunction and thelikelihood of post-amputation complications.
Methods
The NSQIP database for Division of Vascular Surgery from 2022-2023 was queried and 139 amputations were reviewed. Five cases were excluded due to incomplete renal data. A total of 134 cases remained for analysis. Patient data were blinded, and GFR and serum creatinine were measured pre-and post-operatively. Additionally, major medical comorbidities such as diabetes and CAD were reviewed. Need for reintervention, prolonged hospital course, prolonged SNF stay, immobilization, and death were reviewed.
Results
Pre-operatively, 46 patients were identified as having baseline CKD III or worse. Twenty-three patients (17%) had prolonged or unexpected SNF stays. Six patients (4.5%) had elements of hypoxic respiratory failure, with one requiring intubation. Three patients (2%) in this cohort died within the one-year time frame. Eleven patients (8.2%) had excessive bleeding requiring transfusions, with one requiring coil embolization. One patient had a postoperative NSTEMI, leading to eventual CABG. Nineteen out of 23 patients (82.6%) requiring prolonged SNF had elements of renal dysfunction independent of their baseline kidney function. There was no significant change in renal function as measured by postoperative change in GFR or Cr.
Conclusion
Based on our review, renal function did not appear to be an independent predictor of major adverse limb events (MALE) in the immediate postoperative period. This finding is consistent with the current body of literature. However, the degree of renal dysfunction did not reflect the likelihood of MALE. Previous literature shows that GFR fluctuates dramatically in the postoperative period when compared to baseline and that true insults to renal function only present weeks after surgery. Based on our review, the degree of renal dysfunction is not fully predictive of morbidity, mortality, or MALE in the immediate postoperative period. Further review is needed to fully elucidate the degree of renal function as an independent predictor of post-amputation morbidity.
Embargo Period
7-3-2024
Included in
Renal function as a predictor for post-amputation mortality
Philadelphia, PA
Abstract
The impact of renal insufficiency on mortality and healing potential in patients undergoing limb amputation is well-known. Previous literature has pointed towards renal function and dialysis dependency as the largest contributory factors towards postoperative complications. This study reviews renal function as an independent risk factor for post-amputation complications and examines the relationship between the degree of renal dysfunction and thelikelihood of post-amputation complications.
Methods
The NSQIP database for Division of Vascular Surgery from 2022-2023 was queried and 139 amputations were reviewed. Five cases were excluded due to incomplete renal data. A total of 134 cases remained for analysis. Patient data were blinded, and GFR and serum creatinine were measured pre-and post-operatively. Additionally, major medical comorbidities such as diabetes and CAD were reviewed. Need for reintervention, prolonged hospital course, prolonged SNF stay, immobilization, and death were reviewed.
Results
Pre-operatively, 46 patients were identified as having baseline CKD III or worse. Twenty-three patients (17%) had prolonged or unexpected SNF stays. Six patients (4.5%) had elements of hypoxic respiratory failure, with one requiring intubation. Three patients (2%) in this cohort died within the one-year time frame. Eleven patients (8.2%) had excessive bleeding requiring transfusions, with one requiring coil embolization. One patient had a postoperative NSTEMI, leading to eventual CABG. Nineteen out of 23 patients (82.6%) requiring prolonged SNF had elements of renal dysfunction independent of their baseline kidney function. There was no significant change in renal function as measured by postoperative change in GFR or Cr.
Conclusion
Based on our review, renal function did not appear to be an independent predictor of major adverse limb events (MALE) in the immediate postoperative period. This finding is consistent with the current body of literature. However, the degree of renal dysfunction did not reflect the likelihood of MALE. Previous literature shows that GFR fluctuates dramatically in the postoperative period when compared to baseline and that true insults to renal function only present weeks after surgery. Based on our review, the degree of renal dysfunction is not fully predictive of morbidity, mortality, or MALE in the immediate postoperative period. Further review is needed to fully elucidate the degree of renal function as an independent predictor of post-amputation morbidity.