Estimated Glomerular Filtration Rate Predicts Complications Following Artificial Urinary Sphincter Surgery

• Published in: Urology (Ridgewood, N.J.) N.J.), 2022-10, Vol.168, p.208-215
• Main Authors: Riveros, Carlos, Leelani, Navid, Valerio, Elizabeth Di, Bacchus, Michael, Chalfant, Victor, Thomas, Devon, Costa, Joseph
• Format: Article
• Language: English
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2022.06.019

OBJECTIVETo assess whether estimated glomerular filtration rate (eGFR) independently predicts adverse outcomes after AUS surgery. METHODSUsing a large national database, we identified adult males who underwent AUS surgery between 2005-2019. To calculate eGFR (ml/min/1.73 m2), the Cockroft-Gault equation was utilized. Patients were classified into five different groups: 0-29 (advanced chronic kidney disease [CKD]), 30-59 (Stage III CKD), 60-89 (Stage II CKD), 90-119 (normal), and >120 (hyperfiltration). We investigated 30-day outcomes including any complication, readmission, reoperation, major and minor complications, extended length of stay, and non-home discharge. Multivariable logistic regression analysis (MLRA) was performed to assess eGFR categories as independent predictors for each outcome. RESULTSA total of 1,910 cases met inclusion criteria. Patients with advanced CKD had a higher frailty burden (5-item modified frailty index ≥2: 39.1% vs. 22.2%), higher American Society of Anesthesiologists score (ASA III or IV: 95.7% vs. 53.5%), and lower BMI (median kg/m²: 29.3 vs. 30.9) compared to patients with normal eGFR. Likewise, patients with advanced CKD had higher rates of any complication, readmission, reoperation, extended length of stay, non-home discharge, as well as major and minor complications, compared to patients with normal eGFR. On MLRA, advanced CKD (0-29) was independently associated with reoperation (OR 5.14; 95% CI 1.06 - 20.84; p = 0.043). CONCLUSIONSPatients with advanced CKD had a higher likelihood of reoperation when compared to patients with normal eGFR. Patients with advanced CKD should be counseled prior to AUS surgery due to a potential higher risk of 30-day reoperation.