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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Kidney failure Perioperative Major surgery Outcomes Cohort study Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/50a171cbaf4e4083a86077118ad53d77
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spelling	oai:doaj.org-article:50a171cbaf4e4083a86077118ad53d772021-11-08T11:18:04ZMortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study10.1186/s12882-021-02577-71471-2369https://doaj.org/article/50a171cbaf4e4083a86077118ad53d772021-11-01T00:00:00Zhttps://doi.org/10.1186/s12882-021-02577-7https://doaj.org/toc/1471-2369Abstract 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.Tyrone G. HarrisonPaul E. RonksleyMatthew T. JamesShannon M. RuzyckiMarcello TonelliBraden J. MannsKelly B. ZarnkeDeirdre McCaugheyPrism SchneiderJames WickBrenda R. HemmelgarnBMCarticleKidney failurePerioperativeMajor surgeryOutcomesCohort studyDiseases of the genitourinary system. UrologyRC870-923ENBMC Nephrology, Vol 22, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Kidney failure Perioperative Major surgery Outcomes Cohort study Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Kidney failure Perioperative Major surgery Outcomes Cohort study Diseases of the genitourinary system. Urology RC870-923 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
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.
format	article
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
title	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_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_sort	mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/50a171cbaf4e4083a86077118ad53d77
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Mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study

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