Preoperative risk factors for ileostomy-associated kidney injury in colorectal tumor surgery following ileostomy formation.

IF 2.5 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY International Journal of Colorectal Disease Pub Date : 2024-10-14 DOI:10.1007/s00384-024-04732-6
Emi Ota, Jun Watanabe, Hirokazu Suwa, Tomoya Hirai, Yusuke Suwa, Kazuya Nakagawa, Mayumi Ozawa, Atsushi Ishibe, Itaru Endo
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Abstract

Purpose: Diverting ileostomy is related to postoperative high-output stoma (HOS) leading to kidney injury. The purpose of our study was to clarify the risk factors for ileostomy-associated kidney injury, which is kidney injury starting after the first operation to ileostomy closure after colorectal tumor surgery with diverting ileostomy.

Methods: Between January 2013 and December 2020, 442 patients who underwent colorectal tumor surgery (cancer, neuroendocrine tumor, and leiomyosarcoma) following diverting ileostomy formation were included. We used the KDIGO (Kidney Disease Improving Global Outcomes) guidelines, which defines the acute kidney injury (AKI) to classify patients with ileostomy-associated kidney injury. The definition of AKI was (i) serum creatinine (sCr) ≥ 0.3 mg/dL or (ii) sCr ≥1.5-fold the preoperative level. Multivariate analyses were performed to identify the independent risk factors for kidney injury.

Results: Kidney injury developed in 99/442 eligible patients (22.4%). Patients in the kidney injury group were older age, male sex, high American Society of Anesthesiologists Physical Status Classification System (ASA-PS) score, hypertension, cardiovascular diseases, diabetes. The preoperative hemoglobin, albumin, prognostic nutritional index (PNI), and creatinine clearance (CCr) were lower, and the maximum wound length was more extended than the non-kidney injury group. The median highest daily stoma output was significantly higher in the kidney injury group. The postoperative white blood cell (WBC) and C-reactive protein (CRP) levels were also high in the kidney injury group. The univariate analysis showed older age, male sex, high ASA-PS score, hypertension, cardiovascular diseases, and diabetes were the risk factors for kidney injury. The multivariate analysis revealed that age 70 or older, ASA-PS III/IV, hypertension, and HOS ≥2000 ml/day were independent risk factors for kidney injury.

Conclusions: Surgeons should consider diverting colostomy creation for patients with risk factors such as age 70 or older, ASA-PS III/IV, and hypertension.

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结直肠肿瘤手术中回肠造口形成后回肠造口相关肾损伤的术前风险因素。
目的:转流回肠造口与术后高输出造口(HOS)导致肾损伤有关。我们的研究旨在明确回肠造口相关性肾损伤的风险因素,即结直肠肿瘤手术后首次手术后至回肠造口关闭前的肾损伤:方法:纳入2013年1月至2020年12月期间接受结直肠肿瘤手术(癌症、神经内分泌肿瘤和嗜铬细胞瘤)后形成回肠憩室的442例患者。我们采用了KDIGO(肾脏疾病改善全球结果)指南,该指南定义了急性肾损伤(AKI),用于对回肠造口术相关肾损伤患者进行分类。AKI 的定义是:(i) 血清肌酐 (sCr) ≥ 0.3 mg/dL 或 (ii) sCr ≥ 术前水平的 1.5 倍。进行多变量分析以确定肾损伤的独立风险因素:99/442名符合条件的患者(22.4%)出现了肾损伤。肾损伤组患者年龄较大、性别为男性、美国麻醉医师协会体格状态分类系统(ASA-PS)评分较高、患有高血压、心血管疾病和糖尿病。术前血红蛋白、白蛋白、预后营养指数(PNI)和肌酐清除率(CCr)均低于非肾损伤组,最大伤口长度比非肾损伤组更长。肾损伤组的最高造口日排量中位数明显高于非肾损伤组。肾损伤组的术后白细胞(WBC)和 C 反应蛋白(CRP)水平也较高。单变量分析显示,年龄大、男性、ASA-PS 评分高、高血压、心血管疾病和糖尿病是肾损伤的危险因素。多变量分析显示,70 岁或以上、ASA-PS III/IV、高血压和 HOS ≥ 2000 毫升/天是肾损伤的独立危险因素:结论:外科医生应考虑对具有 70 岁或以上、ASA-PS III/IV 和高血压等风险因素的患者实施结肠造口术。
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来源期刊
CiteScore
4.90
自引率
3.60%
发文量
206
审稿时长
3-8 weeks
期刊介绍: The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.
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