Original Articles

Low Preoperative Serum Creatinine is Common and Associated With Poor Outcomes After Nonemergent Inpatient Surgery

Loria, Anthony MD*; Glance, Laurent G. MD†,‡,§; Melucci, Alexa D. MD, MS*; Boodry, Courtney MD, MPH*; Justiniano, Carla F. MD, MPH*; Dunne, Richard F. MD∥; Mustian, Karen M. PhD, MPH; Becerra, Adan Z. PhD#; Jusko, Todd A. PhD‡; Temple, Larissa K. MD, MSc*; Fleming, Fergal J. MD, MPH*

Author Information

*Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York

†Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York

‡Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York

§RAND Health, Rand, Boston, MA

∥Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York

Department of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York

#Department of Surgery, Rush University Medical Center, Chicago, IL

The authors report no conflicts of interest.

[email protected].

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.annalsofsurgery.com.

Annals of Surgery 277(2):p 246-251, February 2023. | DOI: 10.1097/SLA.0000000000005760

Abstract

Objective: 

To assess the association between low preoperative serum creatinine and postoperative outcomes.

Background: 

The association between low creatinine and poor surgical outcomes is not well understood.

Methods: 

We identified patients with creatinine in the 7 days preceding nonemergent inpatient surgery in the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2020. Multivariable logistic regression was used to examine the association between creatinine and 30-day mortality and major complications.

Results: 

Of 1,809,576 patients, 27.8% of males and 23.5% of females had low preoperative serum creatinine, 14.6% experienced complications, and 1.2% died. For males, compared with the reference creatinine of 0.85 to 1.04, those with serum creatinine ≤0.44 had 55% increased odds of mortality [ adjusted odds ratio (aOR), 1.55; 95% CI, 1.29-1.86] and 82% increased odds of major complications (aOR, 1.82; 95% CI, 1.69-1.97). Similarly, for females, compared with the reference range of 0.65 to 0.84, those with serum creatinine ≤0.44 had 49% increased odds of mortality (aOR, 1.49; 95% CI, 1.32-1.67) and 76% increased odds of major complications (aOR, 1.76; 95% CI, 1.70-1.83). These associations persisted for the total cohort, among those with mildly low albumin, and for those with creatinine values measured 8 to 30 days preoperatively.

Conclusions: 

A low preoperative creatinine is common and associated with poor outcomes after nonemergent inpatient surgery. A low creatinine may help identify high-risk patients who may benefit from further evaluation and optimization.

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