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Postoperative Renal Impairment is Associated with Increased Length of Stay for Incisional Hernia Repair after Liver Transplantation

19 Pages Posted: 23 Apr 2019 Publication Status: Under Review

See all articles by James R. Butler

James R. Butler

Indiana University - Department of Surgery

Daniel C. O’Brien

Indiana University - Department of Surgery

Joshua K. Kays

Indiana University - Department of Surgery

Kyle Ridlen

Indiana University - Department of Surgery

Chandrashekhar A. Kubal

Indiana University - Department of Surgery

Burcin Ekser

Indiana University - Department of Surgery

Lava Timsina

Indiana University - Department of Surgery

Jonathan A. Fridell

Indiana University - Department of Surgery

Richard S. Mangus

Indiana University - Department of Surgery

John A. Powelson

Indiana University - Department of Surgery

Abstract

Background: Incisional hernia repair (IHR) is the most common procedure after orthotopic liver transplantation (OLT). Although enhanced recovery protocols are increasingly employed, the post-OLT patient may not benefit from all aspects of these models. The aim of the present study is to assess which perioperative interventions and patient factors effect hospital length of stay in a cohort of post-OLT patients undergoing IHR.

Methods: We conducted a retrospective review of a series of adult patients undergoing IHR after OLT. The primary endpoint was length of stay. Results were stratified by demographic, intraoperative, and postoperative variables.

Results: 172/1523 (11%) patients who received OLT during the study period underwent subsequent IHR. Median length of stay was 5 days (range 2-50). The strongest predictor of length of stay was postoperative renal function. Despite liberal intraoperative administration of volume (median 642 ml/hr) and brisk intraoperative urine output (median 72ml/hr), postoperative acute kidney injury (AKI) occurred in 48% of patients. Those that developed AKI received less intraoperative volume (6 ml/kg/hr vs 8.5 ml/kg/hr; p=0.031) and the severity of postoperative renal injury was inversely related to intraoperative volume.

Conclusions: In patients undergoing IHR after OLT, postoperative renal function is frequently impaired. This finding is likely owed to the enterohepatic circulation of nephrotoxic immunosuppression. Although many aspects of current ERAS protocols may be applied to post-transplant patients, restrictive intraoperative fluid administration strategies should be employed with caution given a high propensity for the development of post-operative AKI in this complex population.

Keywords: Liver transplant, Incisional Hernia, Renal Injury, ERAS

Suggested Citation

Butler, James R. and O’Brien, Daniel C. and Kays, Joshua K. and Ridlen, Kyle and Kubal, Chandrashekhar A. and Ekser, Burcin and Timsina, Lava and Fridell, Jonathan A. and Mangus, Richard S. and Powelson, John A., Postoperative Renal Impairment is Associated with Increased Length of Stay for Incisional Hernia Repair after Liver Transplantation (April 20, 2019). Available at SSRN: https://ssrn.com/abstract=3375093 or http://dx.doi.org/10.2139/ssrn.3375093

James R. Butler

Indiana University - Department of Surgery

United States

Daniel C. O’Brien

Indiana University - Department of Surgery

United States

Joshua K. Kays

Indiana University - Department of Surgery

United States

Kyle Ridlen

Indiana University - Department of Surgery

United States

Chandrashekhar A. Kubal

Indiana University - Department of Surgery

United States

Burcin Ekser

Indiana University - Department of Surgery

United States

Lava Timsina

Indiana University - Department of Surgery

United States

Jonathan A. Fridell

Indiana University - Department of Surgery

United States

Richard S. Mangus

Indiana University - Department of Surgery

United States

John A. Powelson (Contact Author)

Indiana University - Department of Surgery ( email )

United States

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