Renal dysfunction due to surgical stress and its effects on survival in patients aged 90 and over

Risk of renal dysfunction in patients aged 90 years and older



geriatrics, acute kidney injury, mortality


Background/Aim: Published studies of surgical outcomes in patients aged 90 years and older have mostly focused on specific surgeries such as hip fractures. Unlike previous reports, our study includes all surgical procedures in patient groups aged 90 and over for eight years in our hospital. We aim to be able to predict the responses of an older adult’s kidney due to surgical stress by using the values of plasma urea and creatine, which are preoperative and postoperative routine laboratory parameters, and to predict its effect on mortality.

Methods: Our study was conducted as a retrospective cohort study with 284 patients whose ages ranged from 90 to 119 and who had undergone a surgical operation. The patients were divided into four groups according to preoperative and postoperative creatinine values: preoperative and postoperative creatinine <1.25 mmol/L RFT-I group; preoperative creatinine <1.25 mmol/L but postoperative creatinine >1.25 mmol/L RFT-II group; preoperative creatinine >1.25 mmol/L but postoperative creatinine <1.25 mmol/L RFT-III group; and preoperative and postoperative creatinine >1.25 mmol/L RFT-IV group.

Results: Of the 284 cases, 62% required intensive care after surgery. While 95.4% of the patients were discharged, 4.6% did not survive. No renal dysfunction was observed in the RFT-I group (68.7%, n=195) (preoperative and postoperative creatinine <1.25 mmol/L). In the RFT-II group (17.6%, n=50), renal dysfunction (creatinine >1.25 mmol/L) developed due to postoperative surgical stress (creatinine <1.25 mmol/L). In patients in the RFT-III group (6%, n=17), preoperative renal dysfunction (creatinine >1.25 mmol/L) improved with postoperative care (creatinine <1.25 mmol/L). In the RFT-IV group (7.7%, n=22), preoperative renal dysfunction (creatinine >1.25 mmol/L) did not improve postoperative renal dysfunction despite appropriate perioperative fluid replacement.

Conclusion: Our study observed an increase in postoperative urea and creatinine values due to surgical stress in our patient group aged 90 and over, who had limited physiological reserves. However, it has been shown that improvement in renal function tests can be achieved with appropriate fluid replacement and postoperative intensive care treatment in patients with postoperative or preoperative renal dysfunction. Our rates of postoperative renal dysfunction due to surgical stress were lower and did not change mortality.


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Aslan M, Hocaoğlu Ç. Aging and Psychiatric Problems Associated with Aging Period. Journal of Duzce University Health Sciences Institute. 2017;7(1):53-62.

Muravchick S. Anesthesia For The Geriatric Patient, In: Barash PG. Cullen BF. Stoelting RK. Clinical Anesthesia. 5th edition, USA. Lipincott Williams&Wilkins; 2006. pp. 1219-1228.

Erden AI, Akıncı SB, Pamuk AG, Aycan Öİ, Çelebioğlu B, Aypar Ü. Retrospective evaluation of geriatric patients in the intensive care unit. Turkish Journal of Geriatrics. 2009;12(4):171-6.

Vaguhan S. “The Eldery Patient” in High risk patient Ed. By Ian Mc Conachia, Greenwich Medical Media Ltd. Sanfrancisco, USA. 2002. pp. 101-116.

Marino ER. Geriatric anesthesia. In: Butterworth JF, Mackey DC, Wasnick JD (Eds). Morgan& Mikhail’s Clinical Anesthesiology. 5th edition, Lange, Mc Graw Hill, USA. 2013. pp. 907-917.

Türkmen A, Turgut N. Geriatric Anesthesia. Turkish Journal of Geriatrics 2007;10(1):49-56.

Cook DJ, Rooke GA. Priorities in Perioperative Geriatrics. Anesth Analg. 2003;96:1823-36. DOI:

Miric A, Inacio MC, Kelly MP, Namba RS. Are nonagenarians too old for total hip Arthroplasty? An evaluation of morbidity and mortality within a total joint replacement registry. J Arthroplasty. 2015;30:1324-7. DOI:

Bakı ED, Mazlum M, Uçan E, Gökalp M, Korkmaz H, Parpucu A, et al. Retrospectıve investigation of postoperative renal functions of elderly patients that hip prosthesıs performed. Kocatepe Medical Journal. 2021;22(3):208-12. DOI:

Roizen MF, Foss JF, Ficsher SP. Preoperative evaluation, In: Miller RD (Ed). Anesthesia. 5th edition, Churchill Livingstone, USA. 2000. pp. 824-883.

Altun B. Kidney and aging. Turkish Journal of Geriatrics. 1998;1(2):68-71.

Karaman S, Karaman T, Doğru S, Şahin A, Arici S. The effects of anesthsia techniques on mobidity-mortality in geriatric patients underwent orthopedic surgery. Journal of Contemporary Medicine. 2014;4(3):143-50.

Berggren M, Stenvall M, Englund U, Olofsson B, Gustafson Y. Co-morbidities, complications and causes of death among people with femoral neck fracture- a three-year follow-up study. BMC Geriatr. 2016; 16:120. DOI:

Bakı ED, Özcan Ö, Demirboğan ME, Kokulu S, Uzel H, Ela Y, et al. Investigation of the effects of anesthesia techniques on intensive care admission and postoperative mortality in elderly patients undergoing bilateral knee replacement surgery. Turkish Journal of Geriatrics. 2014;17(4):373-81.

Stahl CC, Funk LM, Schumacher JR, Zarzaur BL, Scarborough JE. The Relative Impact of Specific Postoperative Complications on Older Patients Undergoing Hip Fracture Repair. Jt Comm J Qual Patient Saf. 2021;47(4):210-6. DOI:

Kassahun WT, Staab H, Gockel I, Mehdorn M. Factors associated with morbidity and in-hospital mortality after surgery beyond the age of 90: Comparison with outcome results of younger patients matched for treatment. Am J Surg. 2018;216(6):1063-9. DOI:

Ghanem M, Garthmann J, Redecker A, Ahrberg-Spiegl AB, Fakler JKM, Spiegl UJA. Management of pertrochanteric fractures in patients over 90 years: In-hospital mortality rate, complications and associated risk factors. BMC Musculoskelet Disord. 2021;22(1):799. DOI:

Bell S, Dekker FW, Vadiveloo T, Marwick C, Deshmukh H, Donnan TP, et al. Risk of postoperative acute kidney injury in patients undergoing orthopaedic surgery development and validation of a risk score and effect of acute kidney injury on survival: observational cohort study. BMJ. 2015;351:5639. DOI:

Hobson C, Ozrazgat-Baslanti T, Kuxhausen A, Thottakkara P, Efron PA, Moore FA, et al. Cost and Mortality Associated With Postoperative Acute Kidney Injury. Ann Surg. 2015;261(6):1207-14. DOI:

Leistner DM, Münch C, Steiner J, Erbay A, Riedel M, Gebhard C, et al. Impact of acute kidney injury in elderly (≥80 years) patients undergoing percutaneous coronary intervention. J Interv Cardiol 2018;31(6):792-8. DOI:

Perregaard H, Damholt MB, Solgaard S, Petersen MB. Renal function after elective total hip replacement. Acta Orthop. 2016;87(3):235-43. DOI:

Chiang MH, Lee HJ, Kuo YJ, Chien PC, Chang WC, Wu Y, et al. Predictors of In-Hospital Mortality in Older Adults Undergoing Hip Fracture Surgery: A Case-Control Study. Geriatr Orthop Surg Rehabil. 2021;12:21514593211044644. DOI:

Kaşıkara H, Lafçı A. Evaluation of factors affecting mortality in geriatric hip fracture surgery: A retrospective study. Turkish Journal of Geriatrics. 2022;25(3):452-64. DOI:






Research Article

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Kutlusoy S, Koca E, Aydın A. Renal dysfunction due to surgical stress and its effects on survival in patients aged 90 and over: Risk of renal dysfunction in patients aged 90 years and older. J Surg Med [Internet]. 2023 Aug. 25 [cited 2023 Sep. 25];7(8):486-90. Available from: