Mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study
Abstract Background People with kidney failure have a high incidence of major surgery, though the risk of perioperative outcomes at a population-level is unknown. Our objective was to estimate the proportion of people with kidney failure that experience acute myocardial infarction (AMI) or death wit...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12882-021-02577-7 |
| _version_ | 1818933345268006912 |
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| author | Tyrone G. Harrison Paul E. Ronksley Matthew T. James Shannon M. Ruzycki Marcello Tonelli Braden J. Manns Kelly B. Zarnke Deirdre McCaughey Prism Schneider James Wick Brenda R. Hemmelgarn |
| author_facet | Tyrone G. Harrison Paul E. Ronksley Matthew T. James Shannon M. Ruzycki Marcello Tonelli Braden J. Manns Kelly B. Zarnke Deirdre McCaughey Prism Schneider James Wick Brenda R. Hemmelgarn |
| author_sort | Tyrone G. Harrison |
| collection | DOAJ |
| description | Abstract Background People with kidney failure have a high incidence of major surgery, though the risk of perioperative outcomes at a population-level is unknown. Our objective was to estimate the proportion of people with kidney failure that experience acute myocardial infarction (AMI) or death within 30 days of major non-cardiac surgery, based on surgery type. Methods In this retrospective population-based cohort study, we used administrative health data to identify adults from Alberta, Canada with major surgery between April 12,005 and February 282,017 that had preoperative estimated glomerular filtration rates (eGFRs) < 15 mL/min/1.73m2 or received chronic dialysis. The index surgical procedure for each participant was categorized within one of fourteen surgical groupings based on Canadian Classification of Health Interventions (CCI) codes applied to hospitalization administrative datasets. We estimated the proportion of people that had AMI or died within 30 days of the index surgical procedure (with 95% confidence intervals [CIs]) following logistic regression, stratified by surgery type. Results Overall, 3398 people had a major surgery (1905 hemodialysis; 590 peritoneal dialysis; 903 non-dialysis). Participants were more likely male (61.0%) with a median age of 61.5 years (IQR 50.0–72.7). Within 30 days of surgery, 272 people (8.0%) had an AMI or died. The probability was lowest following ophthalmologic surgery at 1.9% (95%CI: 0.5, 7.3) and kidney transplantation at 2.1% (95%CI: 1.3, 3.2). Several types of surgery were associated with greater than one in ten risk of AMI or death, including retroperitoneal (10.0% [95%CI: 2.5, 32.4]), intra-abdominal (11.7% [8.7, 15.5]), skin and soft tissue (12.1% [7.4, 19.1]), musculoskeletal (MSK) (12.3% [9.9, 15.5]), vascular (12.6% [10.2, 15.4]), anorectal (14.7% [6.3, 30.8]), and neurosurgical procedures (38.1% [20.3, 59.8]). Urgent or emergent procedures had the highest risk, with 12.1% experiencing AMI or death (95%CI: 10.7, 13.6) compared with 2.6% (1.9, 3.5) following elective surgery. Conclusions After major non-cardiac surgery, the risk of death or AMI for people with kidney failure varies significantly based on surgery type. This study informs our understanding of surgery type and risk for people with kidney failure. Future research should focus on identifying high risk patients and strategies to reduce these risks. |
| first_indexed | 2024-12-20T04:46:54Z |
| format | Article |
| id | doaj.art-50a171cbaf4e4083a86077118ad53d77 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-20T04:46:54Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-50a171cbaf4e4083a86077118ad53d772022-12-21T19:52:58ZengBMCBMC Nephrology1471-23692021-11-0122111010.1186/s12882-021-02577-7Mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort studyTyrone G. Harrison0Paul E. Ronksley1Matthew T. James2Shannon M. Ruzycki3Marcello Tonelli4Braden J. Manns5Kelly B. Zarnke6Deirdre McCaughey7Prism Schneider8James Wick9Brenda R. Hemmelgarn10Department of Medicine, University of CalgaryDepartment of Community Health Sciences, University of CalgaryDepartment of Medicine, University of CalgaryDepartment of Medicine, University of CalgaryDepartment of Medicine, University of CalgaryDepartment of Medicine, University of CalgaryDepartment of Medicine, University of CalgaryDepartment of Community Health Sciences, University of CalgaryDepartment of Community Health Sciences, University of CalgaryDepartment of Medicine, University of CalgaryDepartment of Medicine, University of CalgaryAbstract Background People with kidney failure have a high incidence of major surgery, though the risk of perioperative outcomes at a population-level is unknown. Our objective was to estimate the proportion of people with kidney failure that experience acute myocardial infarction (AMI) or death within 30 days of major non-cardiac surgery, based on surgery type. Methods In this retrospective population-based cohort study, we used administrative health data to identify adults from Alberta, Canada with major surgery between April 12,005 and February 282,017 that had preoperative estimated glomerular filtration rates (eGFRs) < 15 mL/min/1.73m2 or received chronic dialysis. The index surgical procedure for each participant was categorized within one of fourteen surgical groupings based on Canadian Classification of Health Interventions (CCI) codes applied to hospitalization administrative datasets. We estimated the proportion of people that had AMI or died within 30 days of the index surgical procedure (with 95% confidence intervals [CIs]) following logistic regression, stratified by surgery type. Results Overall, 3398 people had a major surgery (1905 hemodialysis; 590 peritoneal dialysis; 903 non-dialysis). Participants were more likely male (61.0%) with a median age of 61.5 years (IQR 50.0–72.7). Within 30 days of surgery, 272 people (8.0%) had an AMI or died. The probability was lowest following ophthalmologic surgery at 1.9% (95%CI: 0.5, 7.3) and kidney transplantation at 2.1% (95%CI: 1.3, 3.2). Several types of surgery were associated with greater than one in ten risk of AMI or death, including retroperitoneal (10.0% [95%CI: 2.5, 32.4]), intra-abdominal (11.7% [8.7, 15.5]), skin and soft tissue (12.1% [7.4, 19.1]), musculoskeletal (MSK) (12.3% [9.9, 15.5]), vascular (12.6% [10.2, 15.4]), anorectal (14.7% [6.3, 30.8]), and neurosurgical procedures (38.1% [20.3, 59.8]). Urgent or emergent procedures had the highest risk, with 12.1% experiencing AMI or death (95%CI: 10.7, 13.6) compared with 2.6% (1.9, 3.5) following elective surgery. Conclusions After major non-cardiac surgery, the risk of death or AMI for people with kidney failure varies significantly based on surgery type. This study informs our understanding of surgery type and risk for people with kidney failure. Future research should focus on identifying high risk patients and strategies to reduce these risks.https://doi.org/10.1186/s12882-021-02577-7Kidney failurePerioperativeMajor surgeryOutcomesCohort study |
| spellingShingle | Tyrone G. Harrison Paul E. Ronksley Matthew T. James Shannon M. Ruzycki Marcello Tonelli Braden J. Manns Kelly B. Zarnke Deirdre McCaughey Prism Schneider James Wick Brenda R. Hemmelgarn Mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study BMC Nephrology Kidney failure Perioperative Major surgery Outcomes Cohort study |
| title | Mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study |
| title_full | Mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study |
| title_fullStr | Mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study |
| title_full_unstemmed | Mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study |
| title_short | Mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study |
| title_sort | mortality and cardiovascular events in adults with kidney failure after major non cardiac surgery a population based cohort study |
| topic | Kidney failure Perioperative Major surgery Outcomes Cohort study |
| url | https://doi.org/10.1186/s12882-021-02577-7 |
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