Back to 2016 Annual Symposium Abstacts

Objective: Chronic kidney disease has been identified as a significant risk factor for poor post-surgical outcomes. This study was designed to provide a contemporary analysis of Carotid Endarterectomy (CEA) outcomes in patients with chronic kidney disease (CKD), end-stage renal disease (ESRD), and normal kidney function (NF).
Methods: Patients were selected from the Nationwide Inpatient Sample, 2006-2012. Patients with acute renal failure were excluded. Weights were used to calculate national estimates. Postoperative complications, hospital mortality, length of stay (LOS) and costs were analyzed. Three groups were compared using multivariable analysis with age, gender, race, and comorbidities.
Results: A total of 573,723 CEA were identified: 4,801 (ESRD)‘ 32,988 (CKD)‘ and 535,933 (NF). Mean age was 71.1 years, 57.7% were males, and 73.7% were white. Overall hospital mortality was 0.20%: 0.69%, 0.35%, and 0.19% (p<0.0001). There was a higher mortality in ESRD (OR=3.67; 95% CI: 2.59-5.20) and CKD (OR=1.86; 95% CI: 1.53-2.25) compared to NF. The overall stroke rate was 1.6%: 1.8% (ESRD), 2.0% (CKD), and 1.6% (NF), (p<0.0001). Multivariable analysis showed an elevated risk of stroke with CKD (OR=1.13; 95% CI 1.04-1.23) and reduced for ESRD (OR=0.80; 95% CI 0.64-0.99) compared to NF. CKD had significantly more cardiac complications (OR=1.23; 95% CI 1.16-1.32). ESRD and CKD had a higher respiratory complications compared to NF (OR=1.26; 95% CI 1.08-1.47 and OR=1.23; 95% CI 1.15-1.32). There was a significant association between ESRD and NF for sepsis (OR=4.38; 95% CI 3.23-5.94); CKD and NF had no difference. Mean LOS and cost were 2.8 days/\,903, 2.2 days/\,056, and 1.8 days/\,129. Both ESRD and CKD had significantly greater LOS and cost compared to each other and NF (p<0.0001).
Conclusion: Patients with ESRD who underwent CEA had a high risk of respiratory complications and sepsis but not a higher risk of stroke compared to NF. The greatest risks of postoperative stroke and cardiac complications were seen in patients with CKD. Both ESRD and CKD significantly increase hospital mortality, length of stay and cost. Where clinicians typically focus on ESRD, further consideration should be given to patients with CKD not yet on dialysis as they had higher complications including stroke.