Print this pageEffect of Various Levels of Renal Insufficiency on the Outcome of Carotid Endarterectomy
Gilbert Aidinian, MD, Paul W. White, MD, Kent DeZee, MD, Christopher J. Abularrage, MD, Niten Singh, Subodh Arora, MD, William G. Henderson, PhD, Shukri Khuri, MD and Anton N. Sidawy, MD
Veterans Affairs Hospital, Washington, DC, Walter Reed Army Medical Center, Washington, DC and Veterans Affairs Boston Health Care System, Boston, MA
Objective: Renal insufficiency has been shown to negatively influence the outcome of carotid endarterectomy (CEA). The goal of this study is to determine what level of preoperative renal insufficiency increases the risk of postoperative complications after CEA.
Methods: This study is an analysis of prospectively collected data by the National Surgical Quality Improvement Program (NSQIP) of the Veterans Affairs Medical Centers. Patients from 1996-2003 who underwent CEA (n = 20,975) were identified. GFR was calculated and patients were divided into GFR ≥60, 30-59, and <30 cc/min/1.73m2. Only 76 patients were on dialysis preoperatively and were excluded, since meaningful subgroup analysis was lacking in this group. Thirty day postoperative complications and death were assessed using univariate analysis and multivariate logistic regression to control for confounders.
Results: The 30-day mortality and neurologic complications for the entire cohort were 1.2% and 1.8%, respectively. Symptomatic patients had higher odds of death and neurologic complications compared to asymptomatics (OR 1.6, 95%CI:1.1-2.3, P = .006, and OR 2.1, 95%CI:1.6-2.6, P < .001, respectively). Compared to GFR ≥60, only GFR <30 was statistically associated with death (OR 2.7, 95%CI: 1.6-4.8, P < .001). The outcomes are shown in the Table.
Table. Summary of postoperative complications by level of renal function
| GFR 30-59† n = 6423 (30.6%) |
GFR <30† n = 511 (2.4%) | |||||
| Complications (% in GFR ≥60 group) |
OR | 95%CI | P | OR | 95%CI | P |
| Death (1.0%) | 1.2 | 0.9-1.7 | .269 | 2.7* | 1.6-4.8 | <.001 |
| Neurologic(1.7%) | 1.1 | 0.8-1.3 | .652 | 1.5 | 0.9-2.6 | .124 |
| Cardiac (0.9%) | 1.6* | 1.1-2.3 | .009 | 0.6 | 0.2-2.1 | .458 |
| Pulmonary (1.3%) | 1.3* | 1.0-1.7 | .031 | 1.6 | 0.9-2.9 | .105 |
| Infectious (1.5%) | 0.9 | 0.7-1.2 | .664 | 1.9 | 1.0-4.0 | .068 |
† All comparisons are made against GFR ≥60 [13,965 CEAs (66.6%)]as the reference
*P < .05
Conclusion: Preoperative renal insufficiency is a significant predictor of increased risk of death, pulmonary, and cardiac complications after CEA. Careful selection of symptomatic patients with renal insufficiency for CEA is essential.