The Annals of Thoracic Surgery, Vol 58, 524-528, Copyright © 1994 by The Society of Thoracic Surgeons
Renal impairment after thoracotomy: incidence, risk factors, and significance
J Golledge and P Goldstraw
Department of Thoracic Surgery, Royal Brompton National Heart and Lung Hospital, London, United Kingdom.
One hundred thirty patients undergoing major thoracotomy between June 1991
and June 1992 at The Royal Brompton Hospital, London, were analyzed; renal
impairment developed in 31 patients (24%). The mortality and morbidity was
significantly greater for the renal impairment group. Six patients (19%)
with renal impairment died after operation, in contrast to 0 of the 99
patients in whom renal impairment did not develop. The average length of
hospital stay for the patients with renal impairment was 12 days compared
with 8 days for the normal renal function group (p << 0.001). Five
factors were highly significantly associated with renal impairment: a past
history of renal impairment or diuretic intake, undergoing pneumonectomy,
postoperative infection, and blood loss (p < 0.001). The most important
of these appears to be postoperative infection or blood loss, as they also
were associated with death (p = 0.01). Other factors less significantly
associated with renal impairment included a past history of hypertension,
ischemic heart disease, intraoperative gentamicin, and epidural analgesia
(p < 0.01). This study emphasizes that thoracotomy must be considered
carefully in patients with these predisposing factors, particularly if
pneumonectomy is likely. Care must be taken in the use of aminoglycosides
and epidural analgesia. Maintenance of renal blood flow by careful control
of hemodynamic indices appears to be the most important intervention.
