Background

The objectives of this study are to: 1) characterize preoperative serum creatinine (Cr) measurements as a risk factor for morbidity and mortality in patients undergoing metabolic and bariatric surgery (MBS), and 2) elucidate baseline trends in patients undergoing MBS with elevated Cr. Adult patients who underwent non-revisional MBS with complete records in the MBSAQIP database between 01/01/2015 and 01/01/2019 were included. Two groups were created according to pre-operative serum Cr levels (< 1.4 mg/dL vs >= 1.4 mg/dL) and propensity score matching and regression analyses were performed. Patients with a pre-operative Cr level >= 1.4 mg/L were older and more often suffered from diabetes, COPD, sleep apnea, hypertension, and hyperlipidemia. Compared to those with pre-operative Cr levels < 1.4 mg/dL, they were significantly more likely to experience complications within 30 days postoperatively including: mortality (OR 4.05, 95% CI: 2.45-6.70, p<0.001), reoperation (OR 1.48, 95% CI: 1.23-1.79, p<0.001), readmission (OR 1.44, 95% CI: 1.28-1.62, p<0.001), unplanned ICU admission (OR 1.56, 95% CI: 1.28-1.90, p<0.001), > 48 hours of ventilatory support (OR 3.02, 95% CI: 1.92-4.75, p<0.001), unplanned re-intubation (OR 1.78, 95% CI: 1.17-2.74, p<0.01), cardiac arrest requiring CPR (OR 5, 95% CI: 1.91-13.1, p<0.001), blood transfusion (OR 1.69, 95% CI: 1.33-2.14, p <0.001), post-operative stroke (OR 5.5, 95% CI: 1.22-24.8, p=0.01), and treatment for dehydration as an outpatient (OR 1.24, 95% CI : 1.07-1.43, p=0.004) (Figure 1). In conclusion, this analysis demonstrates that elevated pre-operative serum Cr confers significantly increased risk of post-operative morbidity and mortality in patients undergoing MBS.