Does Preoperative Estimated Glomerular Filtration Rate (eGFR) Predict Short-Term Surgical Outcomes in Patients Undergoing Pancreatic Resections?

INTRODUCTION: Preoperative eGFR has been found to be a reliable predictor of post-operative outcomes in patients with normal creatinine levels who undergo surgery. The aim of our study was to evaluate the impact of preoperative eGFR levels on short-term post-operative outcomes in patients undergoing pancreatectomy. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) pancreatectomy file (2014-2017) was queried for all adult patients (age ≥ 18) who underwent pancreatic resection. Patients were stratified into two groups based on their preoperative eGFR (eGFR < 60 mL/min/1.73m2 and eGFR ≥ 60 mL/min/1.73m2). Outcome measures included post-operative pancreatic fistula, discharge disposition, hospital length of stay, 30-day readmission rate, and 30-day morbidity and mortality. Multivariate logistic regression analysis was performed. RESULTS: A total of 21,148 were included in the study of which 12% (n = 2256) had preoperative eGFR < 60 mL/min/1.73m2. Patients in the eGFR < 60 group had prolonged length of stay, were less likely to be discharged home, had higher minor and major complication rates, and higher rates of mortality. On logistic regression analysis, lower preoperative eGFR (< 60 mL/min/1.73m2) was associated with higher odds of prolonged length of stay [aOR: 1.294 (1.166-1.436)], adverse discharge disposition [aOR: 1.860 (1.644-2.103)], minor [aOR: 1.460 (1.321-1.613)] and major complications [aOR: 1.214 (1.086-1.358)], bleeding requiring transfusion [aOR: 1.861 (1.656-2.091)], and mortality [aOR: 2.064 (1.523-2.797)]. CONCLUSION: Preoperative decreased renal function measured by eGFR is associated with adverse outcomes in patients undergoing pancreatic resection. The results of this study may be valuable in improving preoperative risk stratification and post-operative expectations.

A Duty to Describe: Better the Devil You Know Than the Devil You Don't.

Although many researchers have discussed replication as a means to facilitate self-correcting science, in this article, we identify meta-analyses and evaluating the validity of correlational and causal inferences as additional processes crucial to self-correction. We argue that researchers have a duty to describe sampling decisions they make; without such descriptions, self-correction becomes difficult, if not impossible. We developed the Replicability and Meta-Analytic Suitability Inventory (RAMSI) to evaluate the descriptive adequacy of a sample of studies taken from current psychological literature. Authors described only about 30% of the sampling decisions necessary for self-correcting science. We suggest that a modified RAMSI can be used by authors to guide their written reports and by reviewers to inform editorial recommendations. Finally, we claim that when researchers do not describe their sampling decisions, both readers and reviewers may assume that those decisions do not matter to the outcome of the study, do not affect inferences made from the research findings, do not inhibit inclusion in meta-analyses, and do not inhibit replicability of the study. If these assumptions are in error, as they often are, and the neglected decisions are relevant, then the neglect may create a good deal of mischief in the field.