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

  • M. G. Dehne (a1), A. Junger (a1), B. Hartmann (a1), L. Quinzio (a1), R. Röhrig (a1), M. Benson (a1) and G. Hempelmann (a1)...

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.

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Corresponding author

Correspondence to: Dr. med. Bernd Hartmann, Abteilung Anaesthesiologie, Intensivmedizin, Schmerztherapie, Universitätsklinikum Giessen, Rudolf-Buchheim-Strasse 7, D-35392 Giessen, Germany. E-mail: bernd.a.hartmann@chiru.med.uni-giessen.de; Tel: +49 641 99 44401; Fax: +49 641 99 44409

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Keywords

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

  • M. G. Dehne (a1), A. Junger (a1), B. Hartmann (a1), L. Quinzio (a1), R. Röhrig (a1), M. Benson (a1) and G. Hempelmann (a1)...

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