Introduction: More than 15% of the adult population in the US is estimated to have chronic kidney disease (CKD) defined as a glomerular filtration rate (GFR) below 60 ml/min/1.73 m2 for three months or longer. For men with moderate to severe urinary incontinence after prostatectomy, artificial urinary sphincter (AUS) is considered the gold standard treatment. The impact of CKD staging on postoperative complications after AUS surgery is not well defined. The goal of this study was to assess whether male patients with an estimated glomerular filtration rate (eGFR) that is higher or lower than population-based standards have an increased risk of 30-day complications after AUS surgery.
Methods: Using the American College of Surgeons National Improvement Quality Improvement Program (NSQIP) database, we identified adult males who underwent AUS surgery between 2006-2019. To calculate eGFR, the Modification of Diet in Renal Disease (MDRD) equation was utilized: eGFR (ml/min/1.73 m2) = 186 x serum Cr-1.154 x age-0.203 x 1.210 (if African American). Based on eGFR, patients were divided into five different groups: 0-29 (advanced CKD), 30-59 (Stage III CKD), 60-89 (Stage II CKD), 90-119 (Stage I CKD), and >120 (hyperfiltration). We investigated 30-day outcomes including readmission, reoperation, complications (both minor and major), and non-home discharge in all groups. A multivariate logistic regression analysis was performed to control for confounding variables and to identify eGFR categories as an independent risk factor for each outcome.
Results: A total of 2,410 cases met inclusion criteria. Overall, most patients were elderly, overweight, and had hypertension. Patients with advanced CKD had high rates of hypertension (84.4%) and diabetes (43.8%). Patients with advanced CKD had 9.9x higher odds of non-home discharge, 7.1x higher odds of minor complications, and 6.7x higher odds of major complications (p-value <0.05).
Conclusions: Patients with non-advanced CKD had complication rates comparable to patients with better renal function. Patients with advanced CKD (eGFR <30) should be carefully selected prior to AUS surgery due to higher complication rates compared to patients with higher eGFR. Low eGFR may be used to counsel patients about risk for 30-day surgical complications.
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