Matthew G Mullen, MD, J. Hunter Mehaffey, MD, Alex D Michaels, MD, Shoshana Levi, MD, Traci L Hedrick, MD, Charles M Friel, MD. University of Virginia Health System
Objective(s): Ureteral stents are commonly placed prior to colorectal resection to assist in identification of the ureters and preventing injury. Postoperative acute kidney injury (AKI) is a common cause of morbidity and increased cost after colorectal surgery. The prophylactic use of ureteral stents has been associated with reflux anuria, however, it has not previously been found to increase the rates of AKI. We sought to determine the impact of ureteral stents on rates of AKI following colorectal surgery.
Methods: All patients undergoing colon or rectal resection at our institution from 2005-2015 were reviewed using the National Surgical Quality Improvement Program (NSQIP) dataset. Patients with baseline renal failure, stents placed postoperatively, and those with intraoperative ureteral injury were excluded from analysis. Acute kidney injury was defined using the RIFLE criteria (serum creatinine [Cr] increased to 2 times baseline and/or GFR decreased >50%). Univariate and multivariate regression analyses were performed to identify independent predictors of AKI.
Results: 3,491 patients underwent colorectal resection during the study period. Prophylactic ureteral stents were placed in 160 patients (4.6%) prior to surgery. Overall, postoperative AKI occurred in 264 (7.6%) patients within 72 hours. The stent groups demonstrated increased AKI (25.6% vs 6.7%; p<0.0001), readmissions (11.9% vs 7.8%, p<0.0001), and hospital cost ($30,000 vs $25,000, p=0.002). On multivariate regression several factors were identified as independent predictors of AKI after colorectal surgery including age (OR 1.02, p<0.0001), duration of surgery (OR 1.005, p<0.0001), and preoperative stent placement (OR 2.25, p<0.0006). Importantly, type of procedure was not associated with AKI in our risk-adjusted model (c-statistic = 0.797).
Conclusions: Prophylactic ureteral stents independently increased rates of AKI when placed prior to colorectal surgery at our institution. Patient anatomy and surgeon comfort dictate stent placement preoperatively, which is difficult to capture on retrospective analysis. However, these data demonstrate stent placement increases morbidity and cost in colorectal surgery and should be limited to patients with highest potential benefit.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79796
Program Number: S084
Presentation Session: SAGES Got Talent : Resident & Fellow Scientific Session
Presentation Type: ResFel