Background

Serum creatinine can be an indicator of perioperative complications and mortality across various surgical specialties, including metabolic surgery. Renal injury is an important cause of morbimortality associated with surgical procedures, but the true association is unknown. The objective of this study is to determine if high serum creatinine levels (>1.4 mg/dL) can predict morbidity and mortality in those undergoing metabolic surgery.

Methods

A retrospective analysis was performed using the MBSAQIP participant usage file (PUF) database for patients who underwent metabolic surgery between 2015 and 2019. A total of 530.121 patients were divided into two groups, according to serum creatinine levels (> 1.4mg/dL and < 1.4 mg/dL). Data collection included previous medical history, perioperative complications, and mortality. Chi-square analysis and Multinomial Logistic Regression tests were performed. The statistical significance threshold used was p < 0.05.

Results

The incidence of high serum creatinine levels was 2.6%, and this group had more comorbidities (p<0.001). The incidence of surgical conversion, perioperative myocardial infarction (PMI), postoperative acute renal failure, postoperative pulmonary embolism, and overall mortality was found to be significantly higher in the group with high creatinine levels (p<0.001). Elevated creatinine levels were also independently associated with postoperative acute renal failure (p=0.005), but were not independently associated with pulmonary embolism, PMI, mortality, and conversion to open surgery(p>0,05).

Conclusions

Preoperative serum creatinine levels are predictive of postoperative renal conditions and complications after metabolic surgery. Perioperative creatinine levels can be of great use for preoperative preventive measures, defining surgical plans, and for postoperative monitoring.