Renal disease and the surgical patient: Minimizing the impact

Sharma, Kamalesh Kumar; Slawski, Barbara

doi:10.3949/ccjm.85a.17009

Cited by 19 publications

(11 citation statements)

References 57 publications

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“…19,20 Nevertheless, no prophylactic therapy has been consistently shown to protect against the development of AKI. 21 We do not consider preoperative end-stage renal disease to contraindicate TAAAR; approximately 2% of our patients are receiving RRT at the time of surgery. 1 In our practice, during the past decade, 30 patients on dialysis have undergone TAAAR; these patients had 7% 30-day mortality and 20% operative mortality.…”

Section: Renalmentioning

confidence: 98%

Perioperative care after thoracoabdominal aortic aneurysm repair: The Baylor College of Medicine experience. Part 1: Preoperative considerations

Chatterjee

Casar

LeMaire

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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The Texas Medical Center has been home to pioneering aortic surgeons Michael E. DeBakey, Denton A. Cooley, and E. Stanley Crawford, on whose legacies modern thoracoabdominal aortic surgery has been built. During the past 3 decades, our single-center practice (led by J.S.C.) has performed more than 3600 open thoracoabdominal aortic aneurysm repairs (TAAARs), including the largest published series to date (N ¼ 3309). 1 Continuing to refine the perioperative management of TAAAR patients is critical. In this 2-part series, we discuss the current practice at Baylor College of Medicine/CHI Baylor St Luke's Medical Center in Houston, Texas. Part 1 of this report focuses on unique preoperative considerations to reduce the risk of adverse operative outcomes. Part 2 focuses on postoperative management to reduce the risk of complications and to manage those that arise. Although other experienced centers may have different approaches to common conditions and produce good surgical outcomes, we provide this guide as a foundation for surgeons, intensivists, trainees, advanced practice providers, nurses, and others involved in the multidisciplinary management of these complex surgical patients. PREOPERATIVE CONSIDERATIONSWe have described our approach to preoperative planning in detail. 2 Briefly, we assess age and physiologic reserve, stratify risk, stop antiplatelet and anticoagulant medications, advise tobacco cessation, and optimize major neurologic, cardiovascular, respiratory, and renal comorbidities. 3 The major surgical risks include mortality, paraplegia, renal failure, stroke, respiratory failure, and myocardial infarction. Each of these risks is discussed with the patient and family. Surgical timing is influenced by aneurysm size and growth rate; presence of leak, rupture, or acute dissection; and symptomatology (Table 1). 2

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Section: Renalmentioning

confidence: 98%

Perioperative care after thoracoabdominal aortic aneurysm repair: The Baylor College of Medicine experience. Part 1: Preoperative considerations

Chatterjee

Casar

LeMaire

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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show abstract

“…Fourth, in the two previous multicenter prospective cohort studies used for the data source in this study [2,3], postoperative complications were observed. However, when the multivariable analysis was performed to assess the associations between AKI and postoperative outcomes, including length of stay, readmission, and in-hospital mortality, only comorbidities, age, American Society of Anesthesiologists physical status classifications and intraoperative bleeding were used as confounders for statistical adjustment.…”

Section: Dear Editormentioning

confidence: 99%

“…First, in the two previous multicenter prospective cohort studies used as data sources in this study [2,3], only serum creatinine was provided for preoperative assessment of kidney function. However, this study used the incidence of chronic kidney disease to define preoperative kidney function impairment.…”

Section: Dear Editormentioning

confidence: 99%

Acute kidney injury after colorectal surgery with an enhanced recovery pathway

Xue

et al. 2020

Surg Today

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“…Just like the authors had described in the discussion, this is a counterintuitive finding. It is generally believed that a decreased baseline eGFR is a well-established predisposing factor of postoperative AKI and even mild preoperative kidney dysfunction is significant with an increased risk of postoperative AKI [ 2 ]. The authors raised that this counterintuitive finding might be attributable to glomerular hyperfiltration, i.e., a state of little kidney reserve capacity which is intolerable to nephrotoxic insults and prone to the occurrence of AKI.…”

mentioning

confidence: 99%