UP-40 Clinical utility of serial creatinine measurements in patients undergoing radical cystectomy for urothelial cell carcinoma.
Thursday June 27, 2019 from
TBD
Presenter

Christopher Bitcon, Canada

Resident

Department of Urology

Dalhousie University

Abstract

Clinical utility of serial creatinine measurements in patients undergoing radical cystectomy for urothelial cell carcinoma

Christopher Bitcon1, Jenna Coles1, Stewart Whalen1, Ricardo A. Rendon1, Gregory G. Bailly1, David G. Bell1, Ashley R. Cox1, Jon Duplisea1, Karthik Tennankore1, Ross Mason1.

1Department of Urology, Dalhousie University, Halifax, NS, Canada

Introduction: Routine daily blood testing, including serial creatinine (sCr) measurement, is commonly performed in post-operative patients. However, prolonging serial measurements  may lead to unnecessary healthcare spending, prolonged hospital stay, and patient discomfort and anxiety. We examined the rates of clinical actions (CAs) as a result of sCr values as well as post-operative creatinine trends in order to assess the utility of sCr measurements on radical cystectomy (RC) patients.

Methods: We performed a retrospective chart review using our institutions database on all patients who underwent a radical cystectomy for urothelial carcinoma (UC) from 2009 to 2019. Pre-operative and all post-operative inpatient creatinine values were recorded. Minor CAs included fluid boluses, fluid rate changes and medication changes. Major CAs included OR take-backs for stent repositioning, nephrostomy tube placement, nephrology consultation, and hemodialysis.

Results: A total of 237 RCs were performed with a total of 2952 sCr measurements. The median number of sCr measurements per patient was 9 and the median length of hospital stay was 10 days. There were 92 minor and 13 major CAs representing 3% and 0.44% of sCr measurements, respectively. All major CAs were seen in patients experiencing a complicated post-operative course. The most common minor and major CA was a fluid bolus (57) and nephrology consultation (5), respectively. There was no incidence of post-operative dialysis. The median post-operative day with the highest creatinine was day 2.

Conclusion: SCr measurements remain a clinically valuable tool in post-operative management. Nonetheless, this present study suggests that prolonged serial measurement of sCr is of limited clinical utility. As such, discontinuing sCr checks after post-operative day 2 in patients experiencing an uncomplicated post-operative course is safe and may lead to both cost savings and decreased patient discomfort.

 


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